Exploratory thoracotomy on a patient with previous malignancy--"metastasis" or "new primary" or "unrelated lesion"

Surgical resection of a solitary pulmonary metastasis is an established procedure. A medical generation ago when such a shadow appeared on chest roentgenogram of a patient who had known cancer elsewhere in body, it was assumed to be "metastasis" from an extrathoracic site. With increasing advances in knowledge, the occurrence of second primary or new lesion is now no more curiosity in clinical practice. To one's surprise, the lesions that are assumed to be metastatic have often turned out to be "fresh" lesion or even unrelated benign, granulomatous, inflammatory, or parasitic lesion. This paper analyses 66 patients during a period of 20 years who underwent thoracotomy for such solitary pulmonary lesions, and emphasizes the role of diagnostic-cum-therapeutic-thoracotomy in such a clinical situation where in prethoracotomy tissue diagnosis is not forthcoming.