2021 Volume 35 Issue 4 Pages 303-308
A 71-year-old woman was found to have an abnormal shadow on a chest radiograph during a medical checkup. Chest computed tomography (CT) showed a solid nodule in the right S4a segment. The nodule was 1.0×0.9 cm in diameter. She had been treated by chemotherapy for malignant lymphoma at age 49 and achieved complete remission at age 66. Looking back at her previous chest CT performed during the treatment of malignant lymphoma, the solid nodular shadow had been increasing slowly over the last 13 years. Therefore, she was referred to our department for more detailed examination and treatment. Although percutaneous CT-guided transthoracic needle biopsy (CTNB) was performed for diagnostic purposes, a definitive diagnosis was not made. From the chest CT findings and clinical course, inflammatory disease was suspected. However, we decided to perform surgery due to the high risk of carcinogenesis after treatment for malignant lymphoma. We performed right middle wedge resection, and the intraoperative rapid pathological diagnosis was adenocarcinoma. Therefore, we added right middle lobectomy with nodal dissection. From the findings, the tumor was suggested to be secondary malignancy due to chemotherapy for malignant lymphoma. It is extremely rare because it showed a solid nodular shadow from the time of tumor appearance, and there are no reports of slow growing lung adenocarcinoma suggesting secondary malignancies.
