Lung Cancer: Lung Cancer |

Synchronous Primary Lung Cancer: A Rare Disease Entity With Grave Prognosis FREE TO VIEW

Khalid Sherani, MD; Abhay Vakil, MD; Waqas Qamar, MD; Aashir Shah, MD; Kelly Cervellione, MSPH; Mohammad Babury, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A267. doi:10.1016/j.chest.2016.02.279
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Synchronous primary lung cancer (SPLC) is defined as two or more lung tumors detected at the same time without a tumor free period. The estimated incidence of SPLC is reported to be 0.5 % of all the patients with lung cancer. We report the case of a 72-year-old female found to have two bilateral upper lobe masses. Histopathologic examination of the left upper lobe mass revealed adenocarcinoma where as that of the right upper lobe mass revealed small cell lung carcinoma.

CASE PRESENTATION: A 72-year-old female with a 52 pack-year smoking history presented with progressively worsening dry cough and shortness of breath for 3 months duration. She denied any hemoptysis, fever or weight loss. Physical examination was unremarkable. Chest X-ray revealed new bilateral upper lobe masses. Computed tomographic imaging showed a 5.4 x 4 cm right upper lobe and a 3.9 x 3.7 cm left upper lobe mass along with bilateral hilar and subcarinal lymphadenopathy (Fig.1a and b). Histopathologic examination of the left upper lobe mass and right hilar lymph node was suggestive of small cell lung carcinoma (Fig. 2a). After an extensive oncologic work-up patient was started on Carboplatin and Etoposide. Follow up imaging studies after 3 months showed a decrease in the size of left-sided mass and lymphadenopathy. However, the right-sided mass increased in size. Histopathologic examination of the right upper lobe mass revealed adenocarcinoma of lung origin (Fig. 2b). Patient decided to proceed with comfort care measures and died 3 months later.

DISCUSSION: Our case reiterates the importance of differentiating a person with multiple lung masses as having SPLC rather than a single primary with metastatic disease. SPLC continues to pose unique diagnostic and management challenges. Literature review suggests that surgical resection has been attempted in patients presenting with SPLC depending on stage and histopathology of individual primaries. However, 5-year survival was only 20 % in patients undergoing surgery. For non-surgical candidates, stereotactic body radiation, conventional radiation, percutaneous image-guided tumor ablation and adjuvant chemotherapy has been tried.

CONCLUSIONS: Being a relatively uncommon entity, the diagnosis of SPLC needs an high index of suspicion by the clinicians. The stage of tumors at the time of diagnosis has prognostic implications.

Reference #1: Jiang L, He J, Shi X et al. Prognosis of synchronous and metachronous multiple primary lung cancers: Systematic review and meta-analysis. Lung Cancer. 2015 Mar;87:303-10.

DISCLOSURE: The following authors have nothing to disclose: Khalid Sherani, Abhay Vakil, Waqas Qamar, Aashir Shah, Kelly Cervellione, Mohammad Babury

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