A resected case of multiple bilateral lung metastases from primary lung cancer after a 9-year interval

Initial surgery consisting of a right upper lobectomy and lymphadenectomy was performed for a 49-year-old woman with a well-differentiated adenocarcinoma (pT1N0M0). A small nodule was identified on computed tomography (CT) in the left lower lobe 3 years and 6 months after the initial operation. Nine years after the surgery, the nodule had enlarged and another three nodules in the same lobe and a nodule in the right lower lobe were identified. These five nodules were resected in a wedge-shaped manner using video-assisted thoracic surgery. Histological findings verified that all five nodules were metastatic lesions from the lung cancer operated on previously. The patient is currently alive without any recurrence 3 years and 3 months after the second operation. Because the prognosis of patients with bilateral multiple metastases is poor, this case may be very rare. The long interval from the initial operation to the second operation and slow growth of the recurrent tumor in this case might be characteristics suggesting a good prognosis. Because of the rearrangements in the anaplastic lymphoma kinase (ALK) gene detected in the resected lesion, an ALK inhibitor could have been selected for treatment after detection of the rearrangements in the ALK gene in a sample obtained by CT-guided needle biopsy. However, surgery was thought to be more beneficial in this case because the patient has survived without any significant loss of respiratory function or any adverse effects or costs of chemotherapy.