Synchronous Primary Lung Cancer: An Unusual Triple Presentation

TL;DR

A 75-year-old former smoker was diagnosed with three separate primary lung cancers, a rare condition requiring complex treatment decisions.

Contribution

This case highlights the diagnostic and therapeutic challenges of synchronous multiple primary lung cancers through a real-world clinical example.

Findings

Three distinct lung lesions were confirmed as primary adenocarcinomas through biopsy and immunohistochemistry.

The patient underwent a combination of surgical and radiation treatments tailored to the multiple tumors.

The case underscores the importance of multidisciplinary evaluation in managing rare synchronous lung cancers.

Abstract

This case report describes the case of a 75-year-old woman, a former smoker, who began to experience progressive fatigue and shortness of breath. She underwent some tests that did not reveal any significant changes. Still, as the complaints persisted, a computed tomography (CT) scan of the chest was performed, which showed the existence of three suspicious lung lesions, two in the right lung (upper lobe and middle lobe) and one in the left lower lobe. The three lesions were biopsied, which revealed lesions that were positive for CK7 and TTF-1 and negative for p40, suggestive of lung adenocarcinoma. The case was discussed in a multidisciplinary meeting, and the existence of synchronous multiple primary lung cancers (SMPLC) was assumed; hence, it was decided to perform a right bilobectomy and left lower lobe stereotactic body radiation therapy (SBRT). Histology revealed that all the tumors were different, and this was a case of three SMPLC. Despite their rarity, synchronous lung tumors are increasingly diagnosed, bringing with them numerous diagnostic and therapeutic dilemmas, since their overall survival is superior to that of multiple lung metastases from lung carcinoma.

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