[A case report of lung cancer with chest wall invasion arising from a bulla wall]

A 45-year-old man with a history of pulmonary bullae complained of back pain and chest pain while playing golf. His plain chest X-ray film revealed pulmonary bullae and an 8 cm tumorous mass. Although bronchoscopic biopsy was unsuccessful, adenocarcinoma was confirmed by transcutaneous lung biopsy. Because chest wall invasion was found by CT scanning, right upper lobectomy with chest wall resection and dissection of hilar and mediastinal lymph nodes was performed (p-T3N0M0, stage IIIA, relative curative resection). The postoperative course was uneventful and no sign of recurrence is evident eight months later. It was strongly suggested by histopathological study that the chest wall invasion of poorly differentiated adenocarcinoma arose from the bulla wall. Formerly, only two non-curatively resected cases with chest wall invasion of lung cancer arising from a bulla have been reported in Japanese literature.