Additional lobectomy for atypical carcinoid diagnosed after S3 segmentectomy

Abstract

Introduction: Pulmonary segmentectomy is performed for early-stage lung cancer as a limited resection to preserve pulmonary function. However, the criteria for segmentectomy remain controversial. We report a case in which S3 segmentectomy was performed for a very small nodule, and completion lobectomy was required due to the risk of malignant remnants. Case Report: A 70-year-old woman with asthma was referred to our hospital for a ground-glass lung nodule with a solid component. Computed tomography indicated a 0.4-cm solid nodule in the upper lobe segment 3 (S3). S3 segmentectomy was performed because the position of the nodule rendered wedge resection difficult. After the surgery, the pathological analysis revealed that the tumor was an atypical carcinoid, and metastasis was found in the no. 13u lymph node. Thus, completion lobectomy and mediastinal lymph node dissection were performed. Her postoperative course was good, and she had no tumor recurrence 20 months after the surgery. Conclusion: This case demonstrates two key points. First, care should be taken when segmentectomy is indicated, even if the tumor is small. Second, lymph node metastasis may be detected in segmentectomy, which might be missed in lobectomy.