대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 673 Date 2010-09-19

  • Courtesy of Soo-Youn Ham, Yu-Whan Oh / Department of Radiology, Korea University Anam Hospital
  • Age/Sex 62 / M
  • Chief ComplaintHemoptysis (for 3 weeks)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Synchronous lung cancers, both upper lobes (RUL - adenocarcinoma, LUL - squamous cell carcinoma)
Radiologic Findings
Chest PA shows loubulated mass like opacities in both upper lobes. Contrast enhanced chest CT shows well defined mass with spiculated margin in both upper lobes. Right hilar lymph node enlargement is seen. PET-CT shows hypermetabolic masses in the RUL (maxSUV: 11.0) and LUL (maxSUV: 15.5).
Brief Review
Multiple lung cancers are not uncommon, from 1.2 % to .1% of all non-small cell lung cancers, more increased from 1.9 % to 9 % in resected cases. The diagnostic criteria are based from Martini and Melamed. This case is corresponds to the first criteria of tumor with different histology. And the tumors with different subtypes, regardless of nodal status are another type. And similar histology bur arising from separate foci and the last type is similar histology in the absence of metastatic disease in intervening regional and mediastial lymph node stations and the absence of extrathoracic disease. According to Finley DJ et al, among 175 patients, 7% were different histology type tumors. Tumor location, histology and time of diagnosis did not seem to influence survival. Important factors with prolonged survival univariate analysis revealed that decreasing tumor size, fewer pack-years smoking, female sex, T-, N- and overcall pathologic state were associated with improved survival. In our case, the morphologic pattern is similar but tumor size are not remarkably different, and not remarkable metastastic nodules were found in the initial imaging study, so we can suggest synchronous tumor but preoperative biopsy revealed different histology types. Before the surgical resection, PNCA should be considered for the correct preoperative staging.
References
1. Finley DJ, Yoshizawa A, Travis W, Zhou Q, et al. Predictors of outcomes after surgical treatment of synchronous primary lung cancers J Thorac Oncol 2010;5(2):197-205
2. Riquet M, Cazes A, Pfeuty K, et al. Multiple lung cancers prognosis: what about histology? Ann Thorac Surg 2008;86:921-926
3. Vansteenkiste JF, De Belie B, Deneffe GJ, et al. Practical approach to patients presenting with multiple synchronous suspect lung lesions: a reflection on the current TNM classification based on 54 cases with complete follow-up. Lung Cancer 2001 ;34:168-175
4. Martini N, Melamed MR. Multiple primary lung cancer. J Thoac Cardiovas Surg 1975;70:606-612
Keywords
Lung, Malignant tumor,

No. of Applicants : 75

▶ Correct Answer : 7/75,  9.3%
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Doctors Hospital , Bahamas muneesh sharma
  • - CHRU lille , France manuel toledano
  • - Shree Diagnostics , India amol jagdale
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - NDMVP Nashik , India Imran Jindani
▶ Correct Answer as Differential Diagnosis : 33/75,  44.0%
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Okayama university , Japan Takeharu Yamamoto
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - MANSORA CHEST HOSPITAL , Egypt AHMED FAYED
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India;Visitng Prof of Thoracic Surgery KLE University Belgaum , India Bankim Amin
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - All India Institute of medical sciences , India Justin Moses
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Saga University , Japan Ryoko Egashira
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - jobless , France jean-baptiste Noel
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - NASA SCANS , India RAKESH BHATIA
  • - KHOO TECK PUAT HOSPITAL , Singapore SUMER SHIKHARE
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - NMC hospital Dubai , United Arab Emirates vickrant malhotra
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - 2009 , Syria jehad alakabani
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