1989 Volume 11 Issue 2 Pages 170-176
A 71-year-old man was admitted to our hospital because of dyspnea and productive cough. His chest X-ray revealed diffuse reticular opacifications predominantly in the lower lung fields and a nodular shadow in the left lower lung. Pulmonary function tests demonstrated restrictive ventilatory disturbance and blood gas analysis showed hypoxemia. Chest tomograms revealed a cavitary mass in the left S^4. Based on these results, idiopathic interstitial pneumonia (IIP) accompanied by lung cancer was suspected, however pulmonary tuberculosis could not be ruled out because of a positive PPD reaction. Histological and bacteriological examinations using the bronchoscope showed negative results for each possibility. In order to establish the definitive diagnosis and to perform surgical reduction therapy if malignant, we performed wedge resection of the cavitary nodule and open lung biopsy of the left S^9 simultaneously, which histologically revealed squamous cell carcinoma and usual interstitial pneumonia, respectively. In addition to such findings, an endobronchial polypoid tumor was found out in the truncus intermedius through the bronchoscopy. Endoscopic electrosurgery was performed using a wire snare. Histological examination of the removed tumor revealed small cell carcinoma. After endoscopic electrosurgery and wedge resection, both of which were non-curative, corticosteroid was administered for the treatment of IIP. Six months later, when clinical improvement was noted, re-examination was carried out. No recurrence of carcinoma was found endoscopically, radiographically and histologically. In conclusion, it was considered that the stabilization of IIP obtained by the administration of corticosteroid might be related to the suppression of the growth activity of both types of lung cancer.
