Resection of Lung Cancer with Left Atrium Extension via the Pulmonary Vein: Case Report

Shinjiro Mizuguchi,Hiroaki Komatsu,Kantaro Hara,Michihito Toda,Nobuhiro Izumi,Noritoshi Nishiyama,Toshihiko Shibata

doi:10.4236/ojts.2018.81003

Abstract

A 49-year-old man had an abnormal shadow on chest X-ray. Enhanced chest computed tomography (CT) revealed an 8-cm diameter right lung mass invading the right chest wall, with a tumor thrombus extending from the superior pulmonary vein into the left atrium. Transesophageal echocardiography confirmed that the tumor adjoined the side wall of the atrium. Endobronchial and CT-guided needle biopsy demonstrated a low-grade carcinoma or small cell carcinoma. Operative findings through left atriotomy under cardiopulmonary bypass showed no tumor invasion of the atrium wall, but protrusion through the pulmonary vein. Frozen sections revealed a non-small cell carcinoma. We performed right upper lobectomy with parietal pleura and mediastinal lymph node dissection after detachment of cardiopulmonary bypass. Pathological examination demonstrated a large-cell neuroendocrine carcinoma p-T4N0M0, stage IIIA. The patient recovered without postoperative complications and tolerated two cycles of adjuvant chemotherapy. He was doing well without symptoms of recurrence 42 months after surgery.

Highlights

8% - 10% of lung cancers invade the heart, especially the left atrium [1], which can lead to widespread systemic embolization and/or outflow tract obstruction
We present a case of pulmonary large cell neuroendocrine carcinoma complicated with a left atrial tumor thrombus
Operative findings through left atriotomy under cardiopulmonary bypass showed no invasion of the atrium wall by the tumor, which protruded through the pulmonary vein (PV) 1-3, and PV4-5 was intact (Figure 2)

Summary

Introduction

8% - 10% of lung cancers invade the heart, especially the left atrium [1], which can lead to widespread systemic embolization and/or outflow tract obstruction. Treatment of these cases is always warranted. These T4 patients are generally considered to be inoperable [2], and treatment including radical resection presents a therapeutic challenge. We present a case of pulmonary large cell neuroendocrine carcinoma complicated with a left atrial tumor thrombus. After careful preoperative evaluation of the tumor thrombus by ultrasonic cardiography, the patient was treated successfully by right upper lobectomy and atriotomy with cardiopulmonary bypass

Case Report

Discussion