Case Report: A case of synchronous right upper lobe adenocarcinoma and left lower lobe squamous cell carcinoma treated with immune checkpoint inhibitor plus chemotherapy

Abstract

Globally, lung cancer is the leading cause of cancer-related mortality. Multiple primary lung cancers (MPLC) account for a very small portion of all primary lung cancer cases. Importantly, a quick and precise differentiation between MPLC and intrapulmonary metastases is directly related to patient prognoses as treatment strategies vary according to pathological type. Synchronous MPLC are most commonly seen in the same lung. Here, we report a rare case of a patient with synchronous MPLC of both lungs. A 67-year-old man, with a 1-month cough and expectoration history, was admitted in our hospital. Computed tomography (CT) chest scan revealed a lower lobe nodule in the left lung and an upper lobe nodule in the right lung. He underwent successive fiberoptic bronchoscopy and CT-guided percutaneous pulmonary aspiration biopsy of both lungs. The pathological diagnosis was squamous cell carcinoma of the left lung and adenocarcinoma of the right lung.

Keywords: adenocarcinoma; intrapulmonary metastases; multiple primary lung cancers; squamous cell carcinoma; synchronous MPLC.

Figure 1

Computed tomography (CT) scan of the patient throughout the whole course of diagnosis and treatment. Figures A-E, imaging changes of chest CT (mediastinal window and pulmonary window) at different times.

Figure 2

Squamous cell carcinoma. Hematoxylin and eosin staining showing squamous cell carcinoma histology (A). The immunohistochemical examination indicated malignant cells immunoreactive for P40 (B); positive for P63 (C); strongly positive for CK5/6 (D). Magnification 100×.

Figure 3

Adenocarcinoma. Hematoxylin and eosin staining showing adenocarcinoma histology (A). The immunohistochemical examination indicated malignant cells immunoreactive for TTF-1 (B); weakly positive for NapsinA (C); strongly positive for CK7 (D). Magnification 100×.

Figure 4

The timeline of the patient’s events from diagnosis to treatment. CT, computed tomography; FB, fiberoptic bronchoscopy; TP, docetaxel plus nedaplatin; SBRT, stereotactic body radiation therapy; ICI, immune checkpoint inhibitor; PP, pemetrexed plus carboplatin; PR, partial remission; IMRT, intensity-modulated radiation therapy.