Possible delayed cut-end recurrence after limited resection for ground-glass opacity adenocarcinoma, intraoperatively diagnosed as Noguchi type B, in three patients.
BACKGROUND
In our limited resection trial of pulmonary peripheral ground-glass opacity (GGO) lesions from 1998 to 2002, limited resection of Noguchi type A and B carcinomas seemed to have a positive outcome. However, recently three of the 24 patients, with mixed GGO lesions intraoperatively diagnosed as type B, developed a solid lesion at the cut-end scar.


METHODS
Medical records and radiology and pathology findings of the three patients were reviewed. We also analyzed epidermal growth factor receptor gene mutations when possible.


RESULTS
Radiologically, these three second tumors were clearly cut-end scar area recurrences. However, other pathologic and mutation findings suggest metachronous primary cancers developed in Case 1, cut-end recurrence in Case 2, and needle biopsy implantation in Case 3. It is difficult to definitively conclude whether the second tumors were recurrences or metachronous primaries.


CONCLUSIONS
These second tumors have convinced us that our initial caution in concluding GGO lesions can be cured by limited resection was very appropriate. The recurrences definitely indicate that continuing follow-up attention for more than 5 years is needed after limited resection even for GGO bronchioloalveolar carcinomas.
Yoshida
Junji
J
Department of Thoracic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. jyoshida@east.ncc.go.jp
Ishii
Genichiro
G
Yokose
Tomoyuki
T
Aokage
Keiju
K
Hishida
Tomoyuki
T
Nishimura
Mitsuyo
M
Onuki
Takuya
T
Noguchi
Masayuki
M
Nagai
Kanji
K
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000601:surgery*; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000175:diagnosis* / Q000601:surgery*; D000368:Aged; D014408:Biomarkers, Tumor / Q000235:genetics; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D005898:Glass / Q000737:chemistry*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D009367:Neoplasm Staging; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; C512478:EGFR protein, human; D066246:ErbB Receptors