Abstract
A 53-year-old man was diagnosed with non-specific interstitial pneumonia typell (NSIP II) by VATS in February 1998, and was treated with steroids. A total gastrectomy for gastric cancer was performed in September 1999, and in the follow up course, a malignant lung tumor was detected by TBLB. Lung surgery was recommended, but he had already received three abdominal operations after the gastrectomy. He rejected the recommended lung operation because of suffering from abdominal disorders including adhesion ileus and stenosis. An abnormal lung shadow was pointed out to him again in the last treatment for subileus, and he was advised to consult our department for the lung disease on October 15, 2001. He recognized the growing tumor and chose to have the lung operation at that time. A right upper lobectomy and lymph node resection (ND2a) were performed on December 17, 2001. Pathological findings revealed adenocarcinoma of the lung as stageIIB (pT2N1M0) and UIP (usual interstitial pneumonia). The postoperative course was uneventful without deterioration of UIP and he was discharged. He was followed up by checking the serum KL-6 and SP-D concentration for UIP activity. He was admitted to the department of general surgery again because of appetite loss on May 30, 2002. A metastatic liver tumor was found, and he received inpatient chemotherapy and arterial infusion, but UIP gradually became worse and he died of respiratory failure on October 11, 2000, 4 years and 8 months after the first diagnosis of interstitial pneumonia.
