A 49-year-old man had an abnormal shadow on chest X-ray. Enhanced chest
computed tomography (CT) revealed an 8-cm diameter right lung mass invading the
right chest wall, with a tumor thrombus extending from the superior pulmonary
vein into the left atrium. Transesophageal echocardiography confirmed that the
tumor adjoined the side wall of the atrium. Endobronchial and CT-guided needle
biopsy demonstrated a low-grade carcinoma or small cell carcinoma. Operative
findings through left atriotomy under cardiopulmonary bypass showed no tumor
invasion of the atrium wall, but protrusion through the pulmonary vein. Frozen
sections revealed a non-small cell carcinoma. We performed right upper
lobectomy with parietal pleura and mediastinal lymph node dissection after
detachment of cardiopulmonary bypass. Pathological examination demonstrated a
large-cell neuroendocrine carcinoma p-T4N0M0, stage IIIA. The patient recovered
without postoperative complications and tolerated two cycles of adjuvant
chemotherapy. He was doing well without symptoms of recurrence 42 months after
surgery.
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