Delayed cut-end recurrence after wedge resection for pulmonary ground-glass opacity adenocarcinoma despite negative surgical margin.

ABSTRACT

Most pulmonary ground-glass opacity (GGO) nodules are pathologically well differentiated adenocarcinomas. We performed a limited resection trial of GGO lesions 2 cm or smaller from 2003 to 2009, in which 95 patients were accumulated. We confirmed negative surgical cut-end during surgery by margin lavage cytology. In the trial, a 51-year-old man underwent right lower lobe wedge resection for a 1.7 cm mixed GGO lesion. The tumor was papillary predominant adenocarcinoma, pT1NxM0. The resection scar became thicker and was diagnosed as adenocarcinoma by needle biopsy 10 years after the initial surgery. We performed a right lower lobectomy and lymph node dissection. Pathologically, the second tumor was adenocarcinoma similar to the initial one, papillary predominant, and was diagnosed as cut-end recurrence. Small papillary predominant adenocarcinoma might develop delayed cut-end recurrence more than 5 years after limited resection. Careful follow-up with special attention to the cut-end is necessary ideally for 10 years.