A resected case of lung cancer with a displaced anomalous bronchus of the left upper lobe

Abstract

Background. The frequency of anomalous bronchus has been increasing in recent years with the improvement of bronchoscopy and computed tomography (CT) modalities; however, a displaced anomalous bronchus is a rare disorder of the left upper lobe. We herein report a case of surgery for lung cancer with a displaced anomalous bronchus of the left upper lobe. Case. Chest CT showed a 19-mm nodule in the left S1+2 when a 76- year-old man underwent catheterization surgery for a heart attack at the previous hospital. Bronchoscopy did not reveal any malignancy. He was referred to our hospital due to a strong suspicion that the nodule was primary lung cancer (cT1bN0M0 Stage IA2). Three-dimensional chest CT for the preoperative examination revealed a displaced anomalous left B1+2 arising from the left main bronchus and a lack of the left B6. VATS S1+2a+b segmentectomy was performed, and a final diagnosis of poorly differentiated squamous cell carcinoma (pT2aN0M0 Stage IB) was made. No recurrence had occurred by 3.5 years after surgery. Conclusion. The standard surgery for lung cancer with a displaced anomalous bronchus has not yet been established. However, the present case suggests that segmentectomy of the relevant section of a displaced anomalous bronchus is a reasonable approach, and ND2a-1 is preferable for lung cancer with a displaced anomalous bronchus of the left upper lobe, although the anatomical position and surgical margin to the side of the fused fissure must be considered.