Discussion
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,