Abstract
The clinical and histological findings in a case of bronchial carcinoma with a history pulmonary of shell wound are presented.
Adenocarcinoma of the right lower lobe was diagnosed In a 53 year-old male. Thirty four years previously, fragments of a howitzer shell entered through his right back and a piece lodged within his right lower lobe.
He had not experienedced any chest disorder during the last 34 years, but bloody sputum appeared in the summer of 1978. Chest X-ray examinations showed an abnormal shadow in his right lower lung field. In the center of this abnormal shadow, a shell fragment could be observed surrounded by relatively translucent shadow. Sputum cytology showed class V, adenocarcinoma. His right middle and lower lobes were resected and his mediastinal lymph nodes were completely excised.
The resected right lower lobe contained a lot of scar, especially within S6, S8 and S9, due to the penetration of the shell fragments. A shell fragment was present in the peripheral part of B8 and had rough and granular surfaces. The edge of the fragment was as sharp as a knife. A large abscess had formed around the fragment and the wall of the abscess contained a scar continuous to S6.
Microscopic findings, showed the scar to contain many small respiratory ducts and hypertrophied arterioles. The respiratory ducts were surrounded with anthracosis. Well differentiated adenocarcinoma was found mostly around the scar.
The shape of the continuous scar, from S6 to the abscess wall of S8, appeared to follow the contour of the passage of the fragments. Although it is difficult to distinguish the stroma in the malignant lesion adenocarcinoma might have developed in the air ways which lay scattered throughout and/or around scar.
