title: The importance of determining surgical indications in cases of lung cancer and interstitial pneumonia with multiple intrapulmonary lymph nodes.
abstract: BACKGROUND
  When considering treatment for pulmonary cancer complicated by interstitial pneumonia, the greatest problem is acute exacerbation. We report two cases of pulmonary cancer complicated by interstitial pneumonia in which multiple intrapulmonary lymph nodes were noted.
  
  
  METHODS
  Cases 1 and 2 were 76- and 62-year-old males, respectively. Both cases were diagnosed as pulmonary cancer complicated by interstitial pneumonia, and upon chest CT, it was noted that, in addition to the primary lesions, there were multiple nodule shadows under the pleura in the lung lobe, which required identification in order to rule out lung metastasis. In Case 1, the pulmonary nodules were first resected during surgery and a swift diagnosis was made, determining them to be intrapulmonary lymph nodes, which were then operated on curatively. In Case 2, the patient underwent thoracoscopic observation during surgery, the shadows were diagnosed visually as intrapulmonary lymph nodes, and curative surgery was implemented.
  
  
  CONCLUSIONS
  The greatest problem in treating pulmonary cancer complicated with interstitial pneumonia is acute exacerbation, wherein, in the absence of any surgical indications, alternative treatment is limited. Thus, contra-indicating surgery for a patient due to a diagnosis of metastasis within the lungs, based only on nodule images, should be avoided. If nodules are noted in the area of the pleura, the possibility exists that these could be intrapulmonary lymph nodes, along with metastasis within the lung, and thoracoscopic surgery should be implemented proactively while keeping these in mind.
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan. Electronic address: yuki@nms.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nakajima
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Akiyama
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
authors.forename: Maiko
authors.initials: M
authors.lastname: Atari
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Fukuhara
authors.affiliation: Division of Thoracic Oncology, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakai
authors.affiliation: Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kita-adachi-gun, Saitama 362-0806, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Uramoto
keywords: Interstitial pneumonia; Intrapulmonary lymph node; Multiple intrapulmonary nodule; Thoracoscopic surgery