A Case Report of Lung Cancer Contiguous to Bullae That was Difficult to Diagnose

A 66 year-old male was admitted to our hospital under a diagnosis of lung cancer by sputum cytology. Chest roentgenogram showed a mass in the right upper lobe, and emphysematous bullae in the right lower lobe. At first, the former appeared malignant, but a series of chest X-ray examinations during the previous 7 years, CT-scan and transbronchial lung biopsy led us to the diagnosis of lung cancer contiguous to bullae in the latter region. Right lower lobectomy was carried out. Pathological examination revealed well differentiated papillary adenocarcinoma, spreading widely on the surface of bullae and infiltrating into the bulla wall without mass formation. The staging was pT 2 N 2 M 0, pStage III A. We discussed the method of diagnosis of lung cancer adjacent to bullae by a review of 5 cases in our hospital and 30 cases reported in Japan. We emphasize the possibility that lung cancer can arise in association with emphysematous bullae and the necessity of the intensive examinations for the early accurate diagnosis of such lung cancers.