A Case of Lung Cancer Arising from an Emphysematous Bullae and Invading the Chest Wall

A 38-year-old woman with bilateral pulmonary bullae had been followed in another hospital since 1986. She had right chest pain and hemoptysis, and chest x-ray revealed a mass in the right upper lobe in December 1995. Percutaneous lung biopsy failed to obtain sufficient tissue for diagnosis, which suggested the possibility of poorly differentiated adenocarcinoma of the lung. On the other hand, roentgenographic findings suggested the possibility of a tumor arising from the chest wall. Thoracoscopy revealed the infiltration of lung cancer into the chest wall. Resection of the right upper and middle lobes and the invaded chest wall as well as R2b dissection was performed. The lesion, which originated from the wall of a pulmonary bulla, spread by filling inside the bulla and infiltrated into the chest wall. The pathological diagnosis was a poorly differentiated adenocarcinoma of lung (pT3N0M0-stage IIIA). In addition to this case, 12 patients with resected lung cancers arising from pulmonary bullae in our hospital were reviewed.