Adenocarcinoma of Lung and Bronchial Carcinoid Presenting as Double Synchronous Primary Lung Cancer: A Case Report and Review of Literature

Abstract

Recent advances in imaging techniques led to an increase in the incidence of synchronous and metachronous primary lung cancers due to early detection. Management of these patients is challenging and prognosis depends on the stage of the tumor at initial diagnosis and histological type. A 68-year-old African American male patient with medical history of hypertension and diabetes mellitus presented to our emergency department with right sided chest pain, worsening dyspnea and dry cough of 2-week duration. He also reported significant weight loss and was a smoker with 25 pack-years smoking history. Chest radiology showed a large right pleural effusion. Subsequent thoracentesis and fluid analysis revealed a lymphocytic exudate. Patient underwent bronchoscopy with findings of an endobronchial lesion in the left lower bronchus. Microscopic analysis of the biopsy specimen showed a well differentiated carcinoid. It was decided to proceed with VATS and pleural biopsy as part of workup for unexplained exudative pleural effusion. Multiple pleural nodules were detected during the procedure and biopsy of these nodules revealed adenocarcinoma of lung. He was evaluated by Oncology and underwent palliative chemotherapy. The association of carcinoid with adenocarcinoma of lung was infrequently reported in the past. This case also highlights the importance of additional diagnostic workup for primary when the diagnosed malignancy does not explain the clinical presentation.

Lung Adenocarcinoma Complicated with a Carcinoid Microtumor: A Case Report and Literature Review

“…Postoperative pathological examination showed that the tumor was a collision tumor composed of micropapillary adenocarcinoma and typical carcinoid. Saladi et al [15] reported an elderly male cachexia patient with massive pleural effusion in the right lung in 2018. No cancer cells were found in the right pleural effusion puncture.…”

A case of haemoptysis and bilateral areas of lung consolidation sparing the right lower lobe

“…This is why we choose to sample not only the mass but also the areas of consolidation, which showed, in contrast, an indistinctive margin, no bronchial obstruction and diffusion throughout the lungs. All these latter characteristics are typical of PLA [26,27]; however, the coexistence of a pulmonary carcinoid and PLA has rarely been reported [28][29][30][31]. It is still unclear whether identification of sMPLC in resected specimens (including a comprehensive histological assessment) can be applied to limited preoperative biopsy samples, but performing multiple biopsies on different lung sites during bronchoscopy could be particularly useful, especially in the presence of different endoscopic characteristics of the lesions.…”

Synchronous Multiple Primary Cancers of the Lung: The Rare Association of Non-Small Cell Carcinoma With a Carcinoid Tumor

“…In one, the authors described a case of combined lung tumor that contained both squamous cell carcinoma and typical carcinoid tumor [ 3 ]. Sen and and Borczuk and Saladi et al documented synchronous lung tumors that comprised both adenocarcinoma and typical carcinoid tumors [ 1 , 4 ]. Furthermore, Yamagata et al described a case of a laryngeal tumor consisting of both squamous cell and atypical carcinoid tumor components [ 5 ].…”

“…Cases of synchronous but discordant histology with small cell and non-small cell lung carcinoma (NSCLC) occurring in the same patient are rarely reported. To date, there are only a few reported cases of synchronous lung tumors consisting of both NSCLC and carcinoid tumors in the medical literature [ 1 ]. Metachronous tumors are tumors that are also histologically different from one another but occur at different times in the patient.…”