Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Adenocarcinoma Presenting a Solitary Pulmonary Nodule that Grows Slowly Over 10 Years

10년간 크기가 서서히 증가한 고립성 폐결절이 선암으로 진단된 1예

  • Kwon, Ki Du (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Ji Hyeong (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Dae Yong (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Choi, Moon Han (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Choi, Jae Huk (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Shin, Dong Won (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Choi, Jong Hyo (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Yi, Sul Hee (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Yun, Jin A (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Choi, Jae Sung (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Na, Ju Ok (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Seo, Ki Hyun (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Kim, Yong Hoon (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Oh, Mi Hae (Department of Pathology, Soonchunhyang University College of Medicine)
  • 권기두 (순천향대학교 천안병원 내과학교실) ;
  • 김지형 (순천향대학교 천안병원 내과학교실) ;
  • 김대용 (순천향대학교 천안병원 내과학교실) ;
  • 최문한 (순천향대학교 천안병원 내과학교실) ;
  • 최재혁 (순천향대학교 천안병원 내과학교실) ;
  • 신동원 (순천향대학교 천안병원 내과학교실) ;
  • 최종효 (순천향대학교 천안병원 내과학교실) ;
  • 이설희 (순천향대학교 천안병원 내과학교실) ;
  • 윤진아 (순천향대학교 천안병원 내과학교실) ;
  • 최재성 (순천향대학교 천안병원 내과학교실) ;
  • 나주옥 (순천향대학교 천안병원 내과학교실) ;
  • 서기현 (순천향대학교 천안병원 내과학교실) ;
  • 김용훈 (순천향대학교 천안병원 내과학교실) ;
  • 오미혜 (순천향대학교 천안병원 병리학교실)
  • Received : 2008.02.14
  • Accepted : 2008.04.04
  • Published : 2008.04.30
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Abstract

It is difficult to distinguish a lung cancer from a pulmonary tuberculoma or other benign nodule. It is even more difficult to identify the type of lesion if the mass shows no change in size or demonstrates slow growth. Only a pathological confirmation can possibly reveal the nature of the lesion. A 61-year-old-woman was referred for a solitary pulmonary nodule. The nodule showed no change in size for the first two years and continued to grow slowly. Pathological and immunological analyses were conducted for confirmation of the nodule. The nodule was identified as a well-differentiated primary pulmonary adenocarcinoma. An LULobectomy was performed, and the post surgical stage of the nodule was IIIA (T2N2M0). Even though there are few risk factors, there is still the possibility of a malignancy in cases of non-growing or slow growing solitary pulmonary nodules. Therefore, pathological confirmation is encouraged to obtain a firm diagnosis.

본 증례는 2년간 크기의 변화가 없다가 천천히 자라는 고립성 폐결절을 경피부 흉강 세침생검을 시행하여 분화도가 좋은 원발성 폐선암을 진단하였고, 근위 림프절 절제를 포함한 좌상엽절제술을 시행하였다. 저자들은 비록 폐결절 크기의 배가시간이 느리며, 알려진 악성의 위험인자가 거의 없어 양성의 가능성이 높은 폐결절이라 하더라도, 조기에 조직검사 를 포함한 적극적인 검사와 치료가 필요하며, 조직검사가 어려울 경우 크기 변화를 예측하기 위해서는 흉부전산화단층촬영으로 추적관찰 하는 것이 필요 하다고 사료되어 이를 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Ryu NS, Kim SJ, Kim SK, Lee KD, Kim JH, Cho DI, et al. Clinical study on lung cancer associated with pulmonary tuberculosis. Tuberc Respir Dis 1986;33:35-42
  2. Jung TH. Diagnosis of lung cancer. Tuberc Respir Dis 1990;37:337-47
  3. Kho WJ, Kim CH, Jang SH, Lee JH, Yoo CG, Chung HS, et al. Diagnostic approach to the solitary pulmonary nodule: reappraisal of the traditional clinical parameters for differentiating malignant nodule from benign nodule. Tuberc Respir Dis 1996;43:500-18 https://doi.org/10.4046/trd.1996.43.4.500
  4. Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD. The solitary pulmonary nodule. Chest 2003;123:89S-96S https://doi.org/10.1378/chest.123.1_suppl.89S
  5. Lillington GA. Management of solitary pulmonary nodules. Dis Mon 1991;37:271-318
  6. Becker GL, Whitlock WL, Schaefer PS, Tenholder MF. The impact of thoracic computed tomography in clinically staged T1, N0, M0 chest lesions. Arch Intern Med 1990;150:557-9 https://doi.org/10.1001/archinte.150.3.557
  7. Yoon BK, Kim EJ, Kim DI, Lee KH, Ryu JS, Kwak SM, et al. A case of adenocarcinoma presenting a solitary pulmonary nodule that showed no growth over 4 years. Tuberc Respir Dis 2005;59:326-9 https://doi.org/10.4046/trd.2005.59.3.326
  8. Midthun DE, Swensen SJ, Jett JR. Approach to the solitary pulmonary nodule. Mayo Clin Proc 1993;68:378-85 https://doi.org/10.1016/S0025-6196(12)60136-0
  9. Remy-Jardin M, Remy J, Giraud F, Marquette CH. Pulmonary nodules: detection with thick-section spiral CT versus conventional CT. Radiology 1993;187:513-20 https://doi.org/10.1148/radiology.187.2.8475300
  10. Collins VP, Loeffler RK, Tivey H. Observations on growth rates of human tumors. Am J Roentgenol Radium Ther Nucl Med 1956;76:988-1000
  11. Sung DW. Radiological findings of lung cancer: focus on atypical pattern. Tuberc Respir Dis 2005;58:554-61 https://doi.org/10.4046/trd.2005.58.6.554
  12. Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules: Part I. morphologic evaluation for differentiaton of benign and malignant lesions. Radiographics 2000;20:43-58 https://doi.org/10.1148/radiographics.20.1.g00ja0343
  13. Yankelevitz DF, Henschke CI. Does 2-year stability imply that pulmonary nodules are benign? AJR Am J Roentgenol 1997;168:325-8 https://doi.org/10.2214/ajr.168.2.9016198
  14. Woodring JH, Stelling CB. Adenocarcinoma of the lung: a tumor with a changing pleomorphic character. AJR Am J Roentgenol 1983;140:657-64 https://doi.org/10.2214/ajr.140.4.657
  15. Hollings N, Shaw P. Diagnostic imaging of lung cancer. Eur Respir J 2002;19:722-42 https://doi.org/10.1183/09031936.02.00280002
  16. Gupta NC, Maloof J, Gunel E. Probability of malignancy in solitary pulmonary nodules using fluorine- 18-FDG and PET. J Nucl Med 1996;37:943-8
  17. Kim WJ, Yim JJ, Yoo CG, Kim YW, Shim YS, Han SK. Diagnositic efficacy of FDG-PET in solitary pulmonary nodule. Tuberc Respir Dis 1997;44:1263-70 https://doi.org/10.4046/trd.1997.44.6.1263
  18. Kim GS, Im SC, Go YC, Park GH, Ju JY, Jo GJ, et al. Utility of FDG-PET in solitary pulmonary nodules and the relationship between standardized uptake values of PET and serum glucose. Tuberc Respir Dis 2003;55: 589-96 https://doi.org/10.4046/trd.2003.55.6.589
  19. Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med 2003;348: 2535-42 https://doi.org/10.1056/NEJMcp012290
  20. MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, et al. Guidelines for management of small pulmonary solitary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005;237:395-400 https://doi.org/10.1148/radiol.2372041887