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Lung Cancer |

Synchronous Primary Lung Cancers Presenting With Small Cell Carcinoma and Non-small Cell Carcinoma: "A Management Dilemma"

Saad Khan, MD; Markus Kung, MD
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Louis. A. Johnson VA Medical Center, Clarksburg, WV


Chest. 2013;144(4_MeetingAbstracts):603A. doi:10.1378/chest.1688377
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Abstract

SESSION TITLE: Cancer Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Synchronous primary lung cancer (SPLC) is uncommon and is reported to occur in 0.5 % of the lung cancer patients. Among these cases, coexistence of squamous cell and small cell carcinoma is rare and there are no treatment guidelines for these patients. We describe a patient presenting with squamous cell and small cell lung cancer and discuss management options.

CASE PRESENTATION: CASE A 56-year old male with COPD presented with exertional dyspnea, productive cough, low grade fevers and weight loss for 2 weeks. His admission chest radiograph showed a 2.4 x 3.0 cm left supra hilar mass. Computed tomography of chest showed bilateral hilar masses with mediastinal and hilar lymphadenopathy. Bronchoscopy showed submucosal tumor causing marked narrowing of the left upper lobe and lingular bronchi. In addition, a large fungating and friable mass was also found at the junction of right upper lobe and bronchus intermedius. Endobronchial biopsies were obtained from both sides due to difference in the bronchoscopic appearance of tumor on each side. Pathology from the right side revealed poorly differentiated squamous cell cancer and that from the left side revealed small cell lung cancer. PET CT scan showed extensive disease with mediastinal and hilar lymphadenopathy with hyper metabolic lesion in the liver and pancreatic tail. Patient was referred to the oncology service where he received a combination chemotherapy with cisplatin and etoposide.

DISCUSSION: Synchronous primary lung tumor are rare but are increasing recognized due to advances in lung cancer imaging and surgical management. It has been proposed that mutation in the p53 gene secondary to smoking and asbestos exposure predisposes to development of tumor in different foci. The decision to biopsy multiple sites when more than one lesion is detected on imaging is a clinical decision. In this case, difference in endoscopic appearance led us to biopsy both sides. Once SPLC is detected, tumors should be staged separately. Prognosis is dependent on tumor stage and the presence and absence of nodal metastasis. If the patient is a surgical candidate, wedge resection and segmentectomy can be offered for bilateral and pneumonectomy for the ipsilateral lesion in different lobes. Systemic chemotherapy directed at small cell lung cancer is usually chosen for non-surgical cases.

CONCLUSIONS: . This case emphasizes on the importance of recognition of synchronous primary lung cancers, differentiation from metastatic disease and the need for establishment of the diagnosis and optimal treatment of patients having SPLC presenting with SCLC and NSCLC.

Reference #1: Synchronous multiple primary lung cancer: An increasing clinical occurrence requiring multidisciplinary management Delphine Trousse, MDa, Fabrice Barlesi, MDb, Anderson Loundou, PhDc, J Thorac Cardiovasc Surg 2007;133:1193-1200

DISCLOSURE: The following authors have nothing to disclose: Saad Khan, Markus Kung

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