Abstract
Eight cases of resected peripheral lung cancer contiguous with pulmonary bullous disease were examined retrospectively to evaluate the clinical features and roentgenopathological correlation.
The eight patients were all males with a median age of 70 (range 53-75) years and were heavy smokers. Histological types of the carcinomas were poorly differentiated carcinoma (4 adenocarcinoma, 2 large cell carcinoma, 1 squamous cell carcinoma) except one well differentiated adenocarcinoma. Retrospective examination of chest radiographs in seven cases revealed that the radiologist had failed to detect small nodular lesions in three cases, while four cases had no lesions yet. These four cases were undetectable due to the site of the primary tumor superimposed on shadows of bullous disease on the initial chest radiographs, however these primary tumors were detected by computed tomography. Postoperative pathological evaluation showed advanced cases of lung cancer (above stage III A) in five patients.
These cases provide evidence for a strong association between bullous disease of the lung and primary lung cancer. The majority of patients with both diseases undergo surgery when the tumor is at an advanced stage, possibly because it is too late for accurate diagnosis of a concomitant cancer contiguous with pulmonary bullous disease. These eight cases suggest that lung cancer may arise in association with bullous disease, so that intensive examination is needed for early and accurate diagnosis of such lung cancers.
