• Yohei Honda, Soichi Oka, Yasuhiro Chikaishi, Masaaki Inoue, Junichi Yoshida, and Daisei Yasuda.
• Thoracic Surgery, Shimonoseki City Hospital, Shimonoseki, Japan. Electronic address: yo-heyheyhey@hotmail.co.jp.
• Int J Surg Case Rep. 2020 Jan 1; 70: 5-7.

IntroductionGenerally, lung cancer representing as Ground-glass nodules is associated with an early stage and good prognosis. However, we herein report a rare case of pure ground-glass nodules with mediastinal lymph node metastases.Presentation Of CaseA 69-year-old man underwent video assisted thoracic surgery right upper lobectomy with mediastinal lymph node dissection due to multifocal Ground-glass nodules in the right upper lobe of the lung. Histopathologically, six lung adenocarcinomas were present simultaneously. Furthermore, we detected mediastinal lymph nodes metastases that contain micropapillary component. The lung lesion containing micropapillary component was a pure Ground-glass nodule that adjoining pulmonary bulla on CT findings.DiscussionGenerally, lung cancer presenting as pure ground-glass nodules is associated with an early stage and good prognosis. However, the necessity of evaluating the mediastinal lymph nodes in pure ground-glass nodules is controversial. It is reported that lung cancer adjoining the wall of a bulla tends to have a poor prognosis, even when small in size. Therefore, Ground-glass nodules with metastases might have a different pathogenesis than other nodules.ConclusionAdenocarcinoma appearing as pure Ground-glass nodules is associated with early stage lung cancer and a good prognosis. However, the findings in our patient indicate the importance and necessity of evaluating the mediastinal lymph nodes for metastases intraoperatively.Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

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