Coexistent Non-Small Cell Carcinoma and Small Cell Carcinoma in a Patient Presenting with Hyponatremia.

Mitchell D Ross,Jasmine L Huang,Nitika Thawani,Ralph Drosten,Sreeja Biswas Roy,Pradnya D Patil,Tanmay S Panchabhai

doi:10.1155/2018/1718326

Mitchell D Ross, Jasmine L Huang + Show 5 more

Open Access

https://doi.org/10.1155/2018/1718326

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Abstract

Despite recent advances in screening methods, lung cancer remains the leading cause of cancer-related deaths worldwide. By the time lung cancer becomes symptomatic and patients seek treatment, it is often too advanced for curative measures. Low-dose computed tomography (CT) screening has been shown to reduce mortality in patients at high risk of lung cancer. We present a 66-year-old man with a 50-pack-year smoking history who had a right upper lobe (RUL) pulmonary nodule and left lower lobe (LLL) consolidation on a screening CT. He reported a weight loss of 45 pounds over 3 months, had recently been hospitalized for hyponatremia, and was notably cachectic. A CT of the chest showed a stable LLL mass-like consolidation and a 9 × 21 mm subsolid lesion in the RUL. Navigational bronchoscopy biopsy of the RUL lesion revealed squamous non–small cell lung cancer (NSCLC). Endobronchial ultrasound-guided transbronchial needle aspiration of the LLL lesion revealed small cell lung cancer (SCLC). The final diagnosis was a right-sided Stage I NSCLC (squamous) and a left-sided limited SCLC. The RUL NSCLC was treated with stereotactic radiation; the LLL SCLC was treated with concurrent chemotherapy and radiation. In patients with multiple lung nodules, a diagnosis of synchronous multiple primary lung cancers (MPLCs) is crucial, as inadvertent upstaging of patients with MPLC (to T3 and/or T4 tumors) can lead to erroneous staging, inaccurate prognosis, and improper treatment. Recent advances in the diagnosis of small pulmonary nodules via navigational bronchoscopy and management of these lesions dramatically affect a patient's overall prognosis.

Highlights

Lung cancer is by far the leading cause of cancer deaths in both men and women, with roughly 222,500 new cases of lung cancer expected to be diagnosed in 2017 alone [1]
Lung cancer screening has been shown to decrease mortality associated with lung cancer by detecting early-stage lung cancer in high-risk patients [2]
Lung nodules detected on screening computed tomography (CT) can be risk-stratified based on either Fleischner Society recommendations [3] or the Lung-RADS guidelines [4]

Summary

Introduction

Lung cancer is by far the leading cause of cancer deaths in both men and women, with roughly 222,500 new cases of lung cancer expected to be diagnosed in 2017 alone [1]. In addition to detection of early-stage lung cancer, screening programs may incidentally reveal other findings, such as nonmalignant lung nodules and coronary artery disease (based on coronary calcium scoring) [2]. Pulmonary nodules detected during lung cancer screening are managed using the Fleischner Society recommendations [3] or the LungRADS6 guidelines [4]. The most common incidental finding is a single primary malignancy, but synchronous multiple primary lung cancers in varied stages are occasionally diagnosed based on lung cancer screening results [5]. In Western societies, the incidence of synchronous primary lung cancers has been reported to be anywhere from 0.2% to 20% [6,7,8,9,10]. We report the unique presentation, challenging diagnosis, and successful management of non–small cell lung cancer (NSCLC). Small cell lung cancer (SCLC) coexisting in the same patient

Case Presentation

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Discussion