A case of primary lung cancer concomitant with pulmonary non-tuberculous mycobacteriosis in the ipsilateral lobe

Abstract

As a result of the recent spread of high- resolution CT (HRCT), reports of multiple lung cancers have been increasing. However, it is sometimes difficult to distinguish inflammatory from malignant lung nodules even with HRCT findings. We herein report a case of primary lung cancer coexisting with non-tuberculous mycobacteriosis (NTM) in the ipsilateral other lobe. A 69-year-old woman was referred to our hospital because of an abnormal shadow in the right middle lung field on lung cancer screening chest radiograph. Chest HRCT showed a solid nodule with a spicule and pleural indentation and surrounded by scattered shadows in the right upper lobe, and a part-solid ground glass nodule in the right lower lobe. Because we suspected multiple primary lung cancers, we decided to perform lung nodule biopsy via thoracoscopic surgery. The intraoperative pathological diagnosis based on the fresh frozen sections was as follows: the nodule in the right upper lobe was granuloma (suspected mycobacteriosis), and the nodule in the right lower lobe was adenocarcinoma. Therefore, we performed right lower lobectomy with lymph node dissection. Although we could not diagnose the two intrapulmonary nodules accurately before the operation, we could treat each nodule appropriately according to the intraoperative pathological diagnosis.