A well-differentiated fetal adenocarcinoma of the lung with early local recurrence after limited resection

A 42-year-old man was found to have an abnormal shadow during a systematic physical examination. Computed tomography of the chest revealed a mass in the lateral segment of the left lower lobe with parietal contact without pleural effusion or mediastinal lymphadenopathy. Bronchoscopy showed inflammation at the pyramid basal bronchus without visualization of hydatid materials or bud tumor. The hydatid serology, testing for myobacterium tuberculosis in sputum and the histological finding of bronchial biopsy, were negative. Initial surgery of a posterolateral thoracotomy showed a mass with soft consistency adherent to the parietal pleura on the seventh and eighth intercostal space. Because of the technical difficulties of extemporaneous examination, a limited resection was performed. The histopathological exam showed a well-differentiated fetal adenocarcinoma. The patient was re-operated on for complete resection 1 month and 20 days later, she was staged cT2N0M0. At exploration we discovered local recurrence with a 1.5 cm nodule in the same segment. An extended lower lobectomy to the seventh and the eighth rib was performed with lymphadenectomy. The patient was staged as Ib (pT2N0M0) with clear resected margins (R0). She was discharged in good condition from hospital 11 days postoperatively. Review at 2, 6 and 11 weeks showed no complications and chest radiograph revealed no anomaly. No adjuvant therapy was conducted and the patient is under surveillance.