Synchronous, Multiple Primary Lung Cancers: A Report of Three Cases

Abstract

Multiple primary lung cancers (MPLC) are named synchronous if determined simultaneously with the index tumor, and metachronous if the second tumor is diagnosed with an accepted time after the first tumor. It is important for both the rate of survival and treatment alternatives to differentiate synchronous MPLCs from the metastases of the primary lung tumors, and also from the multiple pulmonary metastases of the extra pulmonary tumors. In this study, clinical characteristics, diagnosis and treatment processes of three synchronous MPLC cases diagnosed in our department were assessed.Keywords: Lung cancer, neoplasm metastases, synchronous multiple primary neoplasms INTRODUCTIONMultiple primary lung cancers (MPLC) are divided into two categories, namely synchronous and metachronous. If tumors are determined simultaneously, they are called synchronous, but if the second tumor is determined after a certain time from the detection of the initial lesion, it is called metachronous. In recent years, in parallel with the usage of multislice computed tomography (CT) and positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET), the incidence of synchronous MPCL has increased (1-3). It is highly important to distinguish synchronous MPLS from both lung metastases of primary tumors and multiple lung metastases of non-lung tumors.In this study, clinical features, diagnosis, and treatment periods of three synchronous MPCL cases diagnosed in our clinic were examined. CASE PRESENTATIONS Case 1A 68-year-old male patient presented with the complaint of shortness of breath, fatigue, and weight loss. His physical examination findings were normal. His chest x-ray revealed bilateral hilar fullness and properly limited opacity in the right middle zone. A mass surrounding the intermediate bronchial wall in the right lobe, a 4 cm lobulated lesion at the apical segment of the right lower lobe, a 2.5 cm lobulated lesion in the right middle lobe, a soft tissue appearance, and mediastinal hilar lymph nodes were detected on thorax CT (Figure 1a, b). The patient's bronchoscopy revealed tumor lesions in the right intermediate bronchial wall and at the entry of the left upper lobe bronchus. Histopathological examination of the biopsy taken from the intermediate bronchus revealed the presence of small-cell carcinoma, and the diagnosis of squamous cell carcinoma was also established with the examination of the biopsy taken from the lesion in the left upper lobe (Figure 2).On the cranial magnetic resonance imaging (MRI) performed for the purpose of staging, a 2×2 cm mass consistent with metastasis was observed in the left frontal lobe. Common liver, muscle, and bone metastases were detected on FDG-PET. The maximum standardized uptake value (SUV max ) was 7.65 for

Surgical Treatment of Synchronous Multiple Primary Lung Cancer: Report of Two Cases

“…Therefore, since a surgical approach for patients with resectable tumors offers longer survival, it is an important treatment alternative. [14] We think that curative surgical resection contributed to the survival of our 2 patients.…”