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Vol.38 No.7 contents | Japanese/English |
- Case Report -
A Resected Case of Left Apical Invading Lung Cancer with Isolated Adrenal Metastasis
Katsuyuki Asai, Enjo Hata, Hirozou Sakaguchi, Shingo Ikeda, Ryouji Kawano and Yoichi AnamiDepartment of Surgery, Respiratory Center, Mitsui Memorial Hospital
A 54-year-old man with left anterior chest pain and dullness of the left arm was referred to our hospital. We diagnosed his disease as left apical invading lung adenocarcinoma with left isolated adrenal metastasis (cT3N0M1 stage IV ). Radiation therapy was given to the lung tumor preoperatively in 15×30-Gy doses, which subsequently reduced the tumor size from 5.0×4.2 cm to 3.6×2.5 cm. Resection of the primary lesion was then performed. As the tumor was found to have invaded the left subclavian artery and the brachial plexus, we carried out left upper lobectomy with left cervical and bilateral mediastinal lymph node dissection and combined partial resection of the left subclavian artery and brachial plexus.The defect of the left subclavian artery was repaired with a Gore Tex® tube graft. The left adrenal metastatic lesion was 5.8×4.2 cm in size and was resected through a retroperitoneal approach 28 days following the thoracic operation. Postoperative radiation therapy was also administrated to the resected stump of the primary lesion in 10×20-Gy doses. Pathologically, both resected lesions were poorly differentiated adenocarcinoma and their pathological stage was IV (pT3N0M1). Twelve months after adrenalectomy, this patient is well without recurrent disease and has resumed a normal lifestyle. This case confirms that synchronism between lung cancer and isolated adrenal metastasis does not necessarily represent an unfavorable prognostic factor. In selected cases, combined resection of both tumors can increase the long-term survival period.
key words: Lung cancer, Adrenal metastasis, Adrenalectomy, Superior sulcus tumor
Received: June 1, 1998
Accepted: October 23, 1998
JJLC 38 (7): 877-883, 1998
