Primary lung cancer contiguous with a giant bulla diagnosed by marked increased plasma level of carcinoembryonic antigen (CEA); report of a case

A 57-year-old-man was referred to our hospital for systemic survey of malignancy because of markedly increased CEA plasma level to 150 ng/ml, but no symptoms. Chest computed tomograms revealed 2 × 3 cm-sized elliptical nodules adjacent to a 10 cm-diameter bulla in the right apical segment. No malignant cell was detected through transbronchial brushing cytology. On the right thoracotomy for exploration, the tumor was found in the hilar-sided wall of the bulla invading the azygous vein and right vagal nerve and the right thoracic wall. Right upper lobectomy, together with the resection of the azygos vein, vagal nerve, parietal pleura as well as mediastinal dissection, was done after the intraoperative diagnosis as adenocarcinoma through the incisional biopsy. Postoperative course was uneventful. Pathological diagnosis indicated poorly differentiated adenocarcinoma with high production of CEA. CEA level drastically decreased after operation and returned to normal range after adjuvant chemotherapy. When the CEA level is over 10 ng/ml, the presence of cancer should be cared.