Multiple Ground-Glass Opacities with Different Growth Rates in the Same Lobe of the Lung during the Follow-Up after the Resection of Pulmonary Adenocarcinoma: A Case Report

Abstract

The patient, a 77-year-old male, underwent right middle lobectomy for adenocarcinoma of the lung, pT1aN0M0, in November 2007. In November 2008, chest CT revealed two ground-glass opacities (GGOs) in the right lower lobe. In October 2009, both of these GGOs had increased in size, and three new GGOs were found. In July 2011, all of the five GGOs had increased in size and three new GGOs were found yet again. Right lower lobe S6 segmentectomy was performed on September 6, 2011, and histopathological examination revealed eight pulmonary adenocarcinomas in the right S6; all of them classified as pl0, ly0, v0, pT1aN0M0. Among the eight lesions, the doubling times of five were measured during the follow-up course, and the mean doubling time was 402 days. The mean doubling time of the lesions showing high c-erbB2 expression was significantly lesser than that of the lesions showing low c-erbB2 expression (273 days vs. 488 days, p = 0.047). Despite being localized GGOs that had arisen in the same individual, it should be noted that the growth rate of the GGO lesions may vary according to the expression level of a molecular markers, and some GGO lesions may show rapid increase in size.