Lung carcinoma within a lung bulla wall: literature review and case report

Abstract

Pulmonary emphysema is a common pulmonary disease encountered in daily medical practice. Its management follows specific guidelines but lacks standardized screening for the development of lung cancer. The precancerous theory of emphysematous bulla/cyst is not well described in the literature, with only a few reports of malignancy within an emphysematous bulla wall. We report the case of a 46-year-old man with productive cough and hemoptysis. A chest radiograph showed multiple irregular radiolucencies in both lung apices. Computed tomography revealed bilateral emphysema with a left apical emphysematous bulla that showed a thickened wall and accumulation of fluid within the bullous cavity. Due to life-threatening hemoptysis, a left upper lobectomy and mediastinal lymph node sampling were performed. The pathology report showed pleomorphic carcinoma within the emphysematous cystic wall. Postoperative computed tomography of the abdomen and pelvis showed focal thickening in the left adrenal gland, and adrenal metastatic carcinoma was confirmed. Brain magnetic resonance imaging also showed metastasis. The patient was started on chemotherapy. He died 2 years postoperatively. Twenty-three cases have been reported from 1989 to 2016, but there was no case of metastatic disease within the wall of an emphysematous bulla. Lung emphysema is not routinely screened for cancer development because it is not cost-effective and does not seem to improve patient outcome, but should this practice be reviewed?

Keywords

Blister carcinoma hemoptysis lung neoplasms neoplasm metastasis pulmonary emphysema

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References

Iwata

Nishiyama

Nagano

, et al. Squamous cell carcinoma presenting as a solitary growing cyst in lung: a diagnostic pitfall in daily clinical practice. Ann Thorac Cardiovasc Surg 2009; 15: 174–177.

Hasleton

PS.

Incidence of emphysema at necropsy as assessed by point-counting.

Thorax 1972; 27: 552–556.

Zhang

Wang

Zhao

Jing

Sang

Pulmonary pleomorphic carcinoma: a case report and review of the literature.

Medicine (Baltimore) 2017; 96: e7465.

Ogawa

Shiota

Marukawa

, et al. Lung cancer associated with pulmonary bulla. Case report and review of literature. Respiration 1999; 66: 555–558.

Yoshikawa

Misao

Aoe

Primary lung cancer arising from the wall of a giant bulla in which positron emission tomography was useful for preoperative diagnosis.

Gen Thorac Cardiovasc Surg 2011; 59: 137–140.

Hirai

Hamanaka

Mitsui

Morifuji

Sutoh

Primary lung cancer arising from the wall of a giant bulla.

Ann Thorac Cardiovasc Surg 2005; 11: 109–113.

Ema

Large cell carcinoma on the bullous wall detected in a specimen from a patient with spontaneous pneumothorax: report of a case.

J Thorac Dis 2014; 6: E234–E236.

Tsutsui

Araki

Shirakusa

Inutsuka

Characteristic radiographic features of pulmonary carcinoma associated with large bulla.

Ann Thorac Surg 1988; 46: 679–683.

Hanaoka

Tanaka

Otake

, et al. Primary lung carcinoma arising from emphysematous bullae. Lung Cancer 2002; 38: 185–191.

10.

Mizuguchi

Nishida

Kawata

Izumi

Nishiyama

Inoue

Synchronous double cancers developing from the wall of bullae in the bilateral lungs.

Jpn J Thorac Cardiovasc Surg 2004; 52: 36–40.

11.

Nakamura

Kawaguchi

Fukui

Fukumoto

Okasaka

Yokoi

The development of large-cell carcinoma in the wall of a giant bulla complicated by hemorrhage.

Surg Case Rep 2016; 2: 22.

12.

Nagai

Kurashima

Yoneda

Komatsu

Takahashi

A case of Recklinghausen’s disease associated with multiple emphysematous bullae and lung cancer.

Nihon Kyobu Shikkan Gakkai Zasshi 1989; 27: 625–629.

13.

Ono

Kotuka

Yagyu

Furuse

Oka

Curative surgery for lung cancer invading the aorta with bilateral emphysematous giant bullae: a case report.

Kyobu Geka 1993; 46: 814–817.

14.

Sakamaki

Nakano

Urano

, et al. A case of large cell carcinoma of the lung arising from the inner surface of a pulmonary bulla and complicated by hematoma. Nihon Kyobu Shikkan Gakkai Zasshi 1995; 33: 906–910.

15.

Kanzaki

Onuki

Shioiri

Sato

, et al. A case report of undifferentiated lung cancer difficult in diagnosis by hemoptysis. J Jpn Assoc Chest Surg 1997; 11: 40–44.

16.

Saito

Okuno

Spontaneous regression of a bulla with the development of adenocarcinoma of the lung.

Intern Med 1999; 38:439–41.

17.

Hatakeyama

Tatibana

Suzuki

Kobayashi

Five cases of lung cancer with emphysematous bullae.

Nihon Kokyuki Gakkai Zasshi 2001; 39: 415–418.

18.

Nakamura

Takamori

Miwa

, et al. Rapid-growth lung cancer associated with a pulmonary giant bulla: a case report. Kurume Med J 2003; 50: 147–150.

19.

Shindo

Endo

Onda

Shimada

Inou

Hiruta

Pulmonary large cell carcinoma contiguous to bullae with massive bullous hematoma and hemoptysis; with special reference to 20 cases of Japanese reports.

Kyobu Geka 2005; 58: 787–793.

20.

Sakai

Matsuoka

Tsuwano

, et al. Lung cancer associated with bulla found during an operation of pneumothorax; report of a case. Kyobu Geka 2006; 59: 1209–1212.

21.

Shin

Oda

Matsumoto

, et al. Lung adenocarcinoma originated from bulla wall accompanying spontaneous hemopneumothorax; report of a case. Kyobu Geka 2010; 63: 245–247.

22.

Furukawa

Oto

Yamane

Toyooka

Kiura

Miyoshi

Spontaneous regression of primary lung cancer arising from an emphysematous bulla.

Ann Thorac Cardiovasc Surg 2011; 17: 577–579.

23.

Isaka

Kanzaki

Kikkawa

Maeda

Onuki

Adenocarcinoma developed in the pulmonary giant bulla; report of a case.

Kyobu Geka 2011; 64: 162–164.