CASE REPORT   

Chirurgia 2018 June;31(3):107-11

DOI: 10.23736/S0394-9508.17.04732-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Resection of bilateral early lung cancer associated with multiple ground-glass opacity lesions in both lungs

Junzo SHIMIZU ¹ ✉, Makio MORIYA ¹, Tadashi KAMESUI ¹, Toshiro NAGAYOSHI ², Akitaka NONOMURA ³

¹ Department of Surgery, Hokuriku Central Hospital, Oyabe, Japan; ² Department of Radiology, Hokuriku Central Hospital, Oyabe, Japan; ³ Department of Pathology, Hokuriku Central Hospital, Oyabe, Japan

The patient was a 71-year-old asymptomatic man. Multiple ground-glass opacity (GGO) lesions were found in both lung fields on computed tomography (CT) screening for lung cancer in 2010. Thereafter, the patient had been followed up using CT at irregular intervals until February 2017, when central scar formation in one lesion in each lung was detected on CT, and lung biopsies of these lesions were performed by video-assisted thoracic surgery. Although these lesions were both diagnosed as adenocarcinoma in situ, a far greater number (15-20) of atypical adenomatous hyperplasia lesions (<5 mm in diameter), compared with those identified by CT, were present in specimens of the right and left main lesions obtained by wedge resection. In recent years, along with the widespread of high-resolution CT (HRCT), the detection of small GGO lesions has become more common. In particular, in cases with lung adenocarcinoma, GGO is often found in addition to the triggering main lesion, and multiple GGO lesions may be found, although rarely. Because the number, features, and site of multiple GGO lesions vary among different cases, it is difficult to establish a uniform treatment strategy, and therefore, it is necessary to consider the methods of operation and follow-up observation according to individual cases. When surgical treatment is chosen, careful observation of remaining GGO lesions by HRCT is required postoperatively. If there are changes in the size, features, and density of GGO, additional treatments including re-operation, radiation therapy, and chemotherapy should be considered.

KEY WORDS: Ground-glass opacity - Hyperplasia - Adenocarcinoma in situ