Primary lung cancer arising from the wall of a giant bulla in which positron emission tomography was useful for preoperative diagnosis

Abstract

We report a case of lung cancer arising from the wall of a giant bulla. A 58-year-old man consulted a physician because of bloody sputum. Chest computed tomography (CT) revealed a left upper giant bulla with partial thickness of the wall. Cytology of both sputum and transbronchial brushing was negative at that time. After 6 months follow-up CT scans showed more thickness of the wall, and positron emission tomography (PET) revealed high accumulation of fluorodeoxyglucose in the thickened wall. Because lung cancer was highly suspected, we performed an operation without a definitive diagnosis. The postoperative pathological diagnosis was large cell carcinoma arising from the wall of a giant bulla. Because a preoperative diagnosis is difficult in the case of lung carcinoma associated with bullous disease due to the lack of a characteristic radiological appearance and the difficulty of pathological examination, we emphasize that PET is a useful diagnostic tool.

Treatment of a giant pulmonary emphysematous cyst with primary bronchoalveolar papillary carcinoma in a Shih Tzu dog

“…In human medicine, lung cancer from emphysematous diseases, such as giant bullae and lung cysts, are well known . In addition, bullous emphysema is an important risk factor for the development of primary lung carcinoma.…”

“…In addition, bullous emphysema is an important risk factor for the development of primary lung carcinoma. A 32‐fold increased risk of lung carcinoma has been reported in people with bullous emphysema (6.1%) compared with those without bullous emphysema (0.19%) . Lung carcinoma arising in bullous emphysema accounts for 2.5%‐4.4% of all lung carcinomas, and 7%‐29% of people with a giant bulla have concurrent lung cancer .…”

“…A 32‐fold increased risk of lung carcinoma has been reported in people with bullous emphysema (6.1%) compared with those without bullous emphysema (0.19%) . Lung carcinoma arising in bullous emphysema accounts for 2.5%‐4.4% of all lung carcinomas, and 7%‐29% of people with a giant bulla have concurrent lung cancer . It has been hypothesized that impaired ventilation caused by bullous emphysema results in the accumulation of carcinogens (eg, tobacco), leading to metaplastic transformation of the lining epithelial cells .…”

“…Nevertheless, if early complete resection is achieved, the prognosis of bronchogenic carcinoma with emphysematous disease is similar to that of non‐emphysematous primary bronchogenic carcinoma . Therefore, for the early detection of tumors to recommend surgery without pathologic diagnosis, it is recommended to perform repeated CT scans or positron emission tomography‐CT; however, the latter is not routinely available in veterinary medicine to date.…”

“…Nevertheless, differentiation is not always possible by gross or diagnostic imaging, even with histopathologic evaluation . Some refer to these emphysematous lesions as bullous disease in a lump . Moreover, it is difficult to determine the specific lesion being described because the terms bulla, bleb, and bullous emphysema have been used interchangeably in some reports .…”