Pulmonary adenocarcinoma possibly developed from the cut-end of small-sized adenocarcinoma in the lung periphery as recurrence 13 years after its wedge resection

Abstract

BackgroundIt is a big topic for general thoracic surgery whether still curability can be obtained by limited resection for peripheral small-sized nodules of non-small cell lung cancer (NSCLC) in the current era of frequent computed tomography (CT) use. Accumulation of information on problematic cases would be meaningful for surgeons to select better surgical procedures.Case presentationA 69-year-old man was pointed out an enlarged 2.1-cm solid nodule on the edge of staple line of the residual right upper lobe by chest CT. He had past history of the lung cancer surgery, wedge resection of the same right upper lobe 13 years ago. The pathological findings were 1.1-cm, p-TlbN0M0, p-stage IA2-adenocarcinoma. Thereafter, he received no adjuvant therapy. This time, the trans-bronchial lung biopsy revealed adenocarcinoma. After the completion lobectomy of the residual right upper lobe, the tumor was diagnosed as adenocarcinoma consistent with recurrence of small-sized adenocarcinoma in the lung periphery developed from the cut-end because of similarities between present and previous tumors on histopathology and p53-positivity.ConclusionsWhen limited resection has been performed for small-sized NSCLC presenting solid nodule on thin-slice CT images, long-term postoperative follow-up time will be necessary for monitoring, considering the possibility of cut-end recurrence.

The difference of auxiliary examination parameters between margin recurrence and granuloma on enhanced computed tomography after sublobar resection

“…However, in the overall comparison, there was no significant difference in the development time of margin granulomas and tumor recurrence. Consistent with other cases reported around the world ( 23 - 25 ), our study found a large variance in the time to recurrence in both types of masses. In other reports, some patients with relatively low-grade primary lung cancer who underwent wedge resection were found to have peri-margin recurrence after 13 years ( 25 ), and there were patients with metastatic lung cancer suspected of short-term margin recurrence that eventually proved to be granuloma ( 26 ).…”

“…Normal mucosal epithelia, such as oral, colorectal, and bronchial mucosa secrete CEA, and smoking and aging also lead to elevated serum CEA ( 31 ). Some researchers have pointed out that DWIs has advantages in identifying recurrence in surgical margins and sutured granulomas after lung cancer surgery, but there are also limitations in misdiagnosis, tumor type, and the population examined ( 25 ). Even invasive biopsy cannot guarantee a complete diagnosis.…”