Primary acinic cell carcinoma (ACC) of the lung is extremely rare. The World Health Organization tumor classification defines ACC as "a malignant epithelial neoplasm that demonstrates some cytological differentiation towards (serous) acinar cells". It is considered to be a low-grade malignant tumor. Since the first case described by Fechner in 1972, less than 30 cases have been reported in the literature. The rarity of this tumor may leads it to be confused with other primary lung tumors and incorrectly diagnosed. We reported a female patient with primary ACC of the lung with mediastinum deviation at age of 27 years received a right pneumonectomy. She was followed up for 12 months postoperatively and remains well.
ObjectiveTo study the feasibility and safety of CT-guided preoperative Hookwire localization of pulmonary nodules in clinical application.MethodsClinical data of 102 patients who were scheduled to undergo surgical treatment for pulmonary nodules from June 2015 to April 2020 in the North Ward of Thoracic Surgery Department of Ruijin Hospital were retrospectively analyzed. There were 38 males and 64 females, aged 23-82 (53.2±12.8) years.ResultsAll 102 patients with pulmonary nodules underwent CT-guided preoperative Hookwire localization successfully, with a localization success rate of 100.0%. The localization time was 27.0 (11-67) min; the number of times to adjust the angle during the positioning process was 6.9 (3-14); the needle depth of the positioning needle was 41.5 (16.3-69.1) mm. A total of 48 (47.1%) patients had a small amount of bleeding in the lung tissue in the positioning area after positioning; 53 (51.9%) patients had a small amount of pneumothorax after positioning; 16 (15.7%) patients were found that the positioning needle completely shedded from the lung tissue in the subsequent surgery. One patient was transferred to open thoracotomy because of extensive dense adhesion in the thorax, and the remaining 101 patients were operated on under thoracoscopy. Postoperative pathology showed that 5 (4.9%) patients were adenocarcinoma in situ, 28 (27.5%) were microinvasive adenocarcinoma, 36 (35.3%) patients were invasive carcinoma and 32 (31.3%) patients were benign lesions. No patients had complications or adverse events related to preoperative positioning.ConclusionPreoperative CT-guided localization of Hookwire intrapulmonary nodules is safe and effective, and can meet the intraoperative localization needs of thoracic surgeons in most clinical situations, and is not inferior to other preoperative localization methods currently used in clinics.