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Vol.47 No.4 contents | Japanese/English |
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- Case Report -
Differential Diagnosis of Squamous Cell Carcinoma Difficult to Distingush Between Primary Lung Cancer Tumor Invading the Chest Wall or Chest Wall Tumor Invading the Lung
Shigeru Nakane1, Katsuhiro Nakagawa1, Teruo Iwasaki1, Hiroshi Katsura1, Mitsunobu Tamura1, Kunimitsu Kawahara21Department of Thoracic Surgery, 2Department of Pathology, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Japan
Background. Primary lung cancer tumors invading the chest wall can often be distinguished from chest wall tumors invading the lung, both macroscopically and microscopically. However, in rare instances such tumors may have an unknown primary site. Case. The patient was a 43-year-old man whose chief complaint was back pain. Chest CT images revealed a mass 5 cm in diameter that was in contact with an emphysematous bulla in right S6 and invading the chest wall. Although no tumor cells were found in a transbronchial biopsy specimen, a thoracotomy was performed under a diagnosis of primary lung cancer invading the chest wall. Needle biopsy results indicated that the lung tumor was a squamous cell carcinoma (SCC), and a right lower lobectomy with chest wall resection and lymph node dissection was performed. Histologic examination of the tumor revealed a poorly differentiated SCC located mostly within the chest wall. Slight invasion of tumor cells into the lung parenchyma beyond the elastic membrane of the visceral pleura was detected by elastica-van Gieson staining. Consequently, the tumor was not regarded as a primary lung cancer, but rather a metastatic tumor invading the chest wall or a primary tumor arising from the chest wall was suspected. The primary site of the SCC was investigated postoperatively and a 18F-fluoro-2-deoxy-glucose positron-emission tomographic scanning disclosed abnormal uptake in the anorectal region, though the resected specimen demonstrated an abscess. The results of additional investigations of the upper and lower gastrointestinal tract and otorhinolaryngologic region were negative. Conclusion. A SCC of the chest wall was resected under a suspected diagnosis of a primary lung cancer tumor invading the chest wall. However, macroscopic and histologic examinations revealed the tumor to be a metastatic or primary SCC located in the chest wall.
key words: Lung cancer, Chest wall tumor, Unknown primary cancer, Pulmonary bulla, Squamous cell carcinoma
Received: December 25, 2006
Accepted: July 2, 2007
JJLC 47 (4): 367-372, 2007
