We report a case of interlobar CD, treated successfully with surgery and adjuvant radiotherapy. A 22-year-old woman, asymptomatic, non-smoker, without history of any chronic illness (including tuberculosis) was admitted to thoracic surgery department due to incidental discovery of right parahilar tumour on prophylactic chest radiograph (Figure 1). No evidence of the lesion was present 3 years earlier. There are no clear indications why chest radiographs were ordered by family physician and occupational specialist at that time. Bronchoscopy did not reveal any endobronchial abnormalities, and the bronchioalveolar lavage cytology was normal. Pulmonary function and routine blood tests were within normal range. Chest CT scan demonstrated well-circumscribed, contrast-enhancing tumour in the right horizontal fissure, tightly adherent to branches of pulmonary artery and upper pulmonary vein (Figure 1). No mediastinal lymphadenopathy, any other intrapulmonary or intraabdominal lesions were detected.
Since malignancy could not be ruled out, the right-sided video-assisted thoracoscopy (VATS) and biopsy of the tumour was planned. VATS was performed using three troacars. Inspection of the right hemithorax revealed relatively well-circumscribed, encapsulated solitary mass in horizontal fissure tightly adherent to adjacent interlobar vasculature. Tumour showed hypervascular features, and despite careful dissection, noticeable diffuse bleeding occurred. Complete macroscopic excision of the tumour was considered to be possible, but too risky thoracoscopically. Conversion to conventional axillary thoracotomy was made and tumour excised. Total blood loss was approximately 300 mL. The postoperative period was uneventful and the patient was discharged home on the fifth postoperative day. A pathological examination revealed a 2.5 x 2.5 x 2 cm3 tumour with bright-rose colouration, morphologically consistent with hyaline vascular type of CD without any evidence of malignant transformation (Figure 2). Although the tumour was macroscopically removed, we were doubtful about the radicality of the operation. Margins of apparently tumour-free tissue around the lesion was hard to assess microscopically due to avoidance of extended resection; thus, there was a risk of potential R1 - resection. Because of the tight adherence to pulmonary vessels, as well as to lung parenchyma and possible invasive nature of the tumour, the pulmonary oncology council suggested adjuvant radiation therapy. The patient received three-dimensional conformal radiotherapy to the site of operation in once daily 2 Gy fractions to cumulative radiation dose of 44 Gy. During 6-year follow-up period, the patient is free from recurrence. No complication from surgery or adjuvant radiotherapy has occurred.