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Ann Thorac Surg 2003;75:1069-1070
© 2003 The Society of Thoracic Surgeons
a Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305-8575, Japan
b Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305-8575, Japan
e-mail: hirosato{at}tsukuba.ac.jp
To the Editor:
In 1999, Lenner and coworkers [1] reported cases with late recurrence after resection of stage I lung cancer. Late recurrences in early-stage lung cancer have been rarely observed more than 10 years after complete resection [1, 2]. The following report is of a stage I lung cancer patient with late recurrence 12 years after complete resection.
In September 1989 a 53-year-old woman was admitted for a small nodular lesion in the right lower lobe incidentally noted on a screening chest x-ray film. She was totally asymptomatic with an unremarkable physical examination. She had no remarkable medical history and had never smoked. Chest radiography and computed tomography (CT) scan showed a 2-cm nodule in S6. Bronchoscopic biopsy revealed a well-differentiated papillary adenocarcinoma. No distant metastases were detected. Right lower lobectomy and lymph node dissection were performed, with a pathologic stage of T1N0M0. Careful review of serial chest radiographs spanning 12 years revealed no lesions believed to be recurrence. In February 2002, however, elevated serum CEA (31.9 ng/mL) was found incidentally on mass screening. On chest CT scan multiple small nodular opacities up to 1 cm in both lungs were discovered. Mediastinal lymph nodes were not enlarged. Workup included CT scan of the abdomen, bone scintigram, brain magnetic resonance imaging, endoscopy, barium enema, gynecologic examination, gallium scintigram, examination of thyroid and breast, and other blood tests, the findings of which were normal. The patient underwent a thoracoscopic lung biopsy in May 2002. The histologic appearance of the small nodular opacities were similar to that of the original lung adenocarcinoma. No treatment was offered, and the patient remained in stable condition for an additional 2 months.
A generalization accepted in the treatment of cancer assumes that a cure is present if there is freedom from disease for 5 years. This concept may apply to the majority of cases of lung cancer but rare cases do recur after many years of disease-free survival. Therefore recurrence of lung adenocarcinoma 12 years after complete resection is almost unique. This observation suggests either a long period of dormancy of residual lung adenocarcinoma cells prior to reinitiation of proliferative activity or the presence of a more slowly growing population of residual cells. It is interesting that in both patients reported by Lenner and colleagues as well as in the present case histologic type was well-differentiated adenocarcinoma and that the first site of late recurrence was lung [1]. Metastases in sites other than lung were not found in these 3 patients. Clues to the mechanism of late recurrence may exist in this clinocopathologic information. Whatever mechanism is involved, it is clear that complete resection does not always mean cure [3]. Lung adenocarcinoma represents a life-long threat to some patients and requires constant vigilance by medical practitioners.
References
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