[Stage IV primary lung cancer treated with lobectomy because of refractory ipsilateral pneumothorax]

A 76-year-old man with dyspnea and left side chest pain was admitted to our hospital. Chest roentgenogram showed a left side pneumothorax. Chest computed tomography( CT) showed a mass shadow in S3 and a nodular shadow in S10 of left lung. Drainage of the pleural cavity and a trans-bronchial biopsy was performed, and primary lung adenocarcinoma was diagnosed. Abdominal CT showed a left enlarged adrenal gland. Because pneumothorax was resistant to the treatment by closed drainage, a surgical treatment was performed. Since the main tumor of left upper lobe was adjacent to emphysematous bullae, simple bullectomy was not possible. Accordingly, left upper lobectomy, partial resection of left lower lobe and lymph node dissection were performed. Positron emission tomography( PET)-CT after surgery strongly suggested adrenal gland metastasis and the pathological stage Ⅳ was established in combination with the histopathological examination. Appropriate surgical approach must be considered even for case with the advanced lung cancer, like present case.