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