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Updated: May 7, 2026

Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
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Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer

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Surgical algorithm for heterogeneous bilateral quadruple pulmonary nodules.

Yang Yang1, Haifeng Wang, Ming Liu

  • 1Department of Thoracic Surgery, Pulmonary Hospital, Tongji University, Shanghai, China.

Interactive Cardiovascular and Thoracic Surgery
|September 24, 2013
PubMed
Summary

This study presents a surgical algorithm for managing multiple, distinct lung nodules in a patient. It details the successful treatment of heterogeneous bilateral quadruple pulmonary nodules, including adenocarcinoma and cryptococcal granuloma.

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Area of Science:

  • Thoracic Surgery
  • Pulmonary Medicine
  • Surgical Pathology

Background:

  • A 65-year-old female non-smoker presented with a 6-month history of chest tightness.
  • Chest computed tomography (CT) revealed four distinct lesions: two nodules in the left upper lobe (S3 and S4 segments), one nodule in the left lower lobe, and a ground-glass opacity (GGO) in the right upper lobe.

Observation:

  • Synchronous bilateral thoracoscopic wedge resections were performed for nodule investigation.
  • Intraoperative frozen section pathology indicated malignancy in the left upper lobe nodules, a benign lesion in the left lower lobe, and atypical adenomatous hyperplasia in the right upper lobe GGO.

Findings:

  • Final pathology confirmed well-differentiated adenocarcinoma (pT1bN0M0, IA) in the left S3 segment and moderately to poorly differentiated adenocarcinoma (pT1aN0M0, IA) in the left S4 segment.
Keywords:
AdenocarcinomaCryptococcosisSurgerySynchronous multiple primary lung cancers

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Last Updated: May 7, 2026

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  • The left lower lobe nodule was diagnosed as cryptococcal granuloma, and the right upper lobe GGO as adenocarcinoma in situ.
  • A left upper lobectomy with lymph node dissection was performed based on intraoperative findings.

    • Implications:

    • This case highlights a successful surgical approach for managing heterogeneous bilateral quadruple pulmonary nodules.
    • The presented surgical algorithm offers a potential strategy for similar complex thoracic cases.
    • Early and accurate diagnosis through intraoperative pathology is crucial for guiding surgical management.