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Long-term Disease-Free Survival of a Patient With Synchronous Bilateral Lung Adenocarcinoma Displaying Different EGFR and C-MYC Molecular CharacteristicsGenetics of a Synchronous Lung Adenocarcinoma

Paolo Graziano, MD; Giuseppe Cardillo, MD; Andrea Mancuso, MD; Gregorino Paone, MD; Rita Gasbarra, BScD; Filippo De Marinis, MD; Alvaro Leone, BScD
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From the Anatomic Pathology Unit (Drs Graziano, Gasbarra, and Leone), Thoracic Surgery Unit (Dr Cardillo), Medical Oncology Unit (Dr Mancuso), Department of Cardiovascular and Respiratory Sciences (Dr Paone), and 1st Oncological Pulmonary Unit (Dr De Marinis), San Camillo-Forlanini Hospital, Rome, Italy.

Correspondence to: Paolo Graziano, MD, Anatomic Pathology Unit, San Camillo-Forlanini Hospital, Via Portuense 332, 00149 Rome, Italy; e-mail: pgraziano@scamilloforlanini.rm.it


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1354-1356. doi:10.1378/chest.10-2276
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The main difficulty with multiple lung tumors is distinguishing synchronous and metachronous lesions from second independent primary tumors, particularly when dealing with the same histologic type. Challenging diagnostic hurdles may explain, at least in part, the extremely variable (0%-79%) 5-year survival rate. We present a case report of a patient with synchronous primary adenocarcinoma treated with surgery that exhibited different EGFR gene status, with an exon 19 mutation in the adenocarcinoma of the left upper lobe that was absent in the right upper lobe. Further, specific EGFR and C-MYC amplification events were associated only with the EGFR-mutated lesion. According to an independent evolution theory, these events were classified as early stage, and the patient is still alive and free of disease 70 months after surgery. Molecular evaluation was an important tool to support the diagnosis of synchronous primary adenocarcinoma, which had not been possible with the application of Martini-Melamed criteria.

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