Nakamura Hisashi, Takamori Shinzo, Miwa Keisuke, Fukunaga Mari, Maeshiro Kanetaka, Matsuo Toshihiro, Hayashi Akihiro, Shirouzu Kazuo
Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan.
Kurume Med J. 2003;50(3-4):147-50. doi: 10.2739/kurumemedj.50.147.
A giant bulla of the lung is suggested as a risk factor for lung cancer. Here we report a case with lung cancer in a giant bulla, which showed rapid progression. A 57-year-old man, who had a history of heavy smoking, was admitted to our hospital due to hemoptysis. A chest X-ray revealed a giant bulla with a ground glass shadow and a high fluid level in the right upper lung. Sputum cytology was negative for malignant cells. A chest X-ray a month later showed increases of the size of the radio-opaque shadow and of the air-fluid retention, suggesting pulmonary hemorrhage from the giant bulla. Limited resection or lobectomy was indicated, but pneumonectomy was performed due to the severe air-leak. Macroscopically, a multiple nodular tumor arose from the bulla wall, which might be related to blood flow and necrotic tissue. The postoperative pathological diagnosis was papillary adenocarcinoma. Unfortunately, the patient developed a recurrence of carcinoma in the pleuroperitoneal cavity and died at 2.5 months after the operation. Based on this report and review of other cases in the literature, we should keep in mind the rapid progression of lung cancer in association with an emphysematous bulla.
肺大疱被认为是肺癌的一个危险因素。在此，我们报告一例发生于肺大疱内的肺癌病例，其呈现快速进展。一名57岁有重度吸烟史的男性因咯血入院。胸部X线显示右上肺有一个伴有磨玻璃影和高液平的肺大疱。痰细胞学检查未发现恶性细胞。一个月后的胸部X线显示不透光阴影及气液潴留增大，提示肺大疱出血。本应行局限性切除或肺叶切除术，但因严重漏气而进行了全肺切除术。肉眼可见，多个结节状肿瘤起源于肺大疱壁，这可能与血流及坏死组织有关。术后病理诊断为乳头状腺癌。不幸的是，患者在胸膜腹腔出现癌复发，并于术后2.5个月死亡。基于本报告及对文献中其他病例的回顾，我们应牢记与肺气肿性肺大疱相关的肺癌快速进展情况。
