Abstract
Few reports have described surgical resection for second primary lung cancers originating close to the initial surgical margin for lung cancer. A 64-year-old man had undergone left segmentectomy with lymph node dissection for small peripheral squamous cell lung cancer using video-assisted thoracic surgery, with pathology confirming a small tumor 12 mm in diameter identified about 3 cm from the surgical margin. Eighteen months after initial surgery, computed tomography revealed a 30 mm pulmonary nodule close to the initial surgical margin in the residual left upper lobe and the serum level of carcinoembryonic antigen was found to be increased. Local recurrence on the staple-line of the surgical margin was suspected, and completion left upper lobectomy was performed. Histological examination identified not only a squamous cell carcinoma component but also a small cell carcinoma component. The immunohistochemical staining pattern of the second tumor differed from that of the initial resected lung squamous cell carcinoma. The final pathological diagnosis was a second primary tumor with mixed small cell carcinoma and squamous cell carcinoma histology.
Highlights
Small peripheral malignant lung tumor has increasingly been treated by limited resection using videoassisted thoracic surgery (VATS) to minimize the volume of lung resected and the size of the thoracotomy incision [1]
We report a case of a second primary lung cancer originating close to the initial surgical margin for a previous lung squamous cell carcinoma and treated by surgical segmentectomy
Tumor cells of the small cell carcinoma component showed positive staining for thyroid transcription factor 1 (TTF-1), chromogranin A (CGA), synaptophysin, and CD56 (Figure 3(c)) but negative staining for p63 and CK5/6 (Figure 3(d))
Summary
Small peripheral malignant lung tumor has increasingly been treated by limited resection using videoassisted thoracic surgery (VATS) to minimize the volume of lung resected and the size of the thoracotomy incision [1]. Staplers have routinely been used and various complications of the surgical margins have been reported [2,3,4] with this increasing use. A new lesion originating close to the initial surgical margin during postoperative follow-up is one such complication. Principal differential diagnoses for such lesions include local recurrence of the initial lung malignancy, nontuberculous mycobacterial infection or fungal infection caused by nonanatomical stapling, and foreign-body granuloma. To the best of our knowledge, only one previous report [5] has described a second primary lung cancer originating close to the initial surgical margin. We report a case of a second primary lung cancer originating close to the initial surgical margin for a previous lung squamous cell carcinoma and treated by surgical segmentectomy
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