A case of simultaneous resection of N2-positive pulmonary enteric adenocarcinoma with signet ring cell feature presenting as a pure ground glass nodule and solid papillary adenocarcinoma

Abstract

Case. A 68-year-old woman with a history of an operation for gastric ulcer and radiotherapy for laryngeal and pharyngeal cancers was referred to our department with a solid nodular lesion of 20 mm and a pure ground glass type nodule (GGN) in the left lung demonstrated on chest computed tomography (CT) taken during a routine follow-up. Systemic check-up including FDG-PET showed accumulation in the solid nodule of the left lower lobe. The nodular lesion was diagnosed as adenocarcinoma during surgical excisional biopsy; thus, lower lobectomy and wedge resection of pure GGN with mediastinal dissection were added. Postoperative pathological diagnoses were TTF-1-positive papillary adenocarcinoma only in the solid pulmonary lesion, and TTF-1-negative enteric adenocarcinoma with signet ring cell features in the GGN lesion involving mediastinal nodes. CBDCA+TS-1 was introduced as adjuvant chemotherapy; however, the treatment was disconrinued by the second course due to severe nausea. Conclusion. Even if CT shows pure GGN alone, advanced disease with mediastinal involvement cannot be ruled out.