EP1.17-01 Surgical Resection of Synchronous Quadruple Primary Lung Tumors Present as Three-Different Cancers and One Benign Mass

Abstract

Synchronous triple lung cancer is uncommon and little is known, making it difficult to establish proper guidelines or treatment strategies. In this report, we describe a 70-year-old male with three synchronous independent and histologically different primary cancers and one benign hamartoma. Chest CT showed a 30 mm-sized lobulated lung mass in posterior basal segment of the left lower lobe (tumor 1) (Figure 1A). In addition, there were another 26 mm-sized well defined solid nodule in the right lower lobe (tumor 2) (Figure 1A). Two sub-centimeter nodules were also presented in superior segment of the right lower lobe (tumor 3) (Figure 1B) and the lingular segment of the left upper lobe (tumor 4) (Figure 1B). A transthoracic percutaneous needle aspiration biopsy performed on the 30 mm-sized nodule in the left lower lobe revealed it as squamous cell carcinoma. During the right side surgery, intraoperative frozen biopsy of tumor 2 and tumor 4 were reported as chondroid hamartoma and adenocarcinoma, respectively. As we already knew that the left side tumor was squamous cell carcinoma, we decided to continue left side surgery with mediastinal lymph node dissection. The final results of the pathological examination of tumor 1 showed squamous cell carcinoma of pT2bN1M0 (Figure 2A), stage IIB. Tumor 2 was diagnosed as chondroid hamartoma (Figure 2B). Small nodules located in the right lower lobe (tumor 3) and left upper lobe (tumor 4) were 6 mm-sized adenocarcinoma with visceral pleural invasion (pT2aNx) (Figure 2C) and 7 mm-sized adenoid cystic carcinoma (pT1aN0) (Figure 2D), respectively. There was no recurrence during the 3-year follow-up period. Appropriate preoperative staging work up including HRCT and percutaneous needle aspiration biopsy can allow timely detection of synchronous multiple lung cancer, offer proper surgical strategy, and give the possibility of implementing potentially curative treatment for patients conventionally misdiagnosed or considered as metastasized.