PURPOSE: A few investigators have suggested the possible association between lung cancer and pulmonary bulla. Its carcinogenic correlation is not yet understood but some peculiar clinical features could be pointed out. The purpose of this study is to clarify clinical features and disclose a problem.
METHODS: 306 cases with primary lung cancer that underwent surgical operation from 1998 to 2003 were studied by reevaluation of chest CT scan. The cancer adjoined the bulla in 11 cases. In which, clinical course and surgical result were investigated.
RESULTS: Incidence was 3.59% of surgical cases. All were men. Average age was 58.8 years old. Three were under age of 49. All were smoker. Initial symptom was common respiratory symptoms in four cases, which included two cases whose symptoms were caused by enlarged hiler lymph node. The other cases were founded by surveillance chest X-ray or health check program. Cancer was located in the bulla only in one case. In other cases, cancer existed in close proximity to the bulla. Histological type was 2 adenocarcinoma, 5 squamous, 2 adenosquamous, and 2 large cell carcinoma. Differentiation tends to be poor. Though all cases received surgical resection successfully, pneumonectomy was necessary in two cases. Positive pleural lavage cytology, which means occult dissemination, was confirmed in four cases. The p-stage was one 1A, three 1B, three 2B, three 3A, and one 3B(PM). The survival curve was almost identical with that of Stage 3A.
CONCLUSION: Primary lung cancer adjoining pulmonary bulla tends to be an advanced one, even if it is small in size. Some reports also suggested the higher incidence of lung cancer among the bulbous lung disease in comparison with that among the general population. Low-density mass shadow adjoining the bulla should be carefully examined and resected in an early stage.
CLINICAL IMPLICATIONS: Improvement of survival after surgical treatment of lung cancer that caused by early diagnosis and treatment.
DISCLOSURE: Masanori Kaneda, None.