An endobronchial recurrence of resected lung adenocarcinoma
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CASE REPORT
An endobronchial recurrence of resected lung adenocarcinoma Shin Koyama1 · Kazuhito Funai1 · Akikazu Kawase1 · Kiyomichi Mizuno1 · Mayu Fukushima2 · Satoshi Baba2 · Norihiko Shiiya1 Received: 5 March 2020 / Accepted: 28 August 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract We report a rare case of endobronchial metastasis arising from peripheral lung adenocarcinoma 12 months after its complete resection. A 69-year old man underwent left upper lobectomy and lymph node dissection. A year after surgery, a bronchial nodule was identified at the left main bronchus through a computed tomography study. A bronchoscope examination showed that the bronchial nodule in the cartilage was located apart from the stump of the upper bronchus. Thus, bronchoscopic resection was performed. The pathological diagnosis was papillary adenocarcinoma, which was identical to the pathology of the previously resected lung cancer. Endobronchial metastasis from the primary lung cancer was confirmed. The present case highlights that clinicians should pay more attention to this rare recurrence pattern of lung cancer. Keywords Endobronchial metastasis · Recurrence · Lung adenocarcinoma · TTF-1
Introduction Endobronchial metastasis from peripheral lung cancer is extremely rare. We herein present an unusual case of endobronchial metastasis from peripheral lung adenocarcinoma after left upper lobectomy.
Case Chest computed tomography (CT) demonstrated a solid mass measuring 3.5 cm in the left upper lobe segment 3 in a 69-year old man’s lung (Fig. 1a). The mass could not be diagnosed by bronchoscopy due to insufficient sampling. 18-Fluoro-deoxyglucose positron emission tomography/CT (18FDG-PET/CT) scanning and brain magnetic resonance imaging (MRI) revealed no lymph nodes and/ or distant metastases. We strongly suspected cT2aN0M0 stage IB lung cancer. He was admitted to our hospital, and * Kazuhito Funai kfunai@hama‑med.ac.jp 1
First Department of Surgery, Hamamatsu University School of Medicine, 1‑20‑1 Handayama, Higashi‑ku, Hamamatsu, Shizuoka 431‑3192, Japan
Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
2
a wedge resection of the left upper lung was performed for diagnosis. Intraoperative rapid pathologic examination revealed an adenocarcinoma. We completed a left upper lobectomy with accompanying hilar and mediastinal lymph node dissection. Pathological examination of the resected specimen confirmed the diagnosis of lung adenocarcinoma with an acinar growth pattern (60%), papillary growth pattern (25%), and micropapillary growth pattern (15%). The visceral pleura was not affected. Pathological staging was pT2aN0M0 stage IB. Neither an epidermal growth factor receptor (EGFR) mutation nor an anaplastic lymphoma kinase (ALK) rearrangement was detected. A month after surgery, oral administration of uracil/tegafur (UFT) was started as an adjuvant therapy, a year after surgery, a bronchial nodule was found at the left main bronchus through CT imaging (Fig. 1b
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