title: Two lung adenocarcinomas in the same lobe: multiple primaries or intrapulmonary metastasis?
abstract: Abnormal nodules were found in the left lung of a 52-year-old woman in segments 6 and 10 on a chest CT. These nodules showed no changes for 18 months, and we discontinued follow-up. Almost 5 years later, an abnormal shadow was found in her left lower lung field on a medical check-up chest X-ray. Chest CT revealed that the left segments 6 and 10 nodules had grown. We diagnosed these lesions as synchronous double primary lung cancers in the same lobe based on the disease history and performed a left lower lobectomy and lymph node dissection. Pathological examination of both tumors revealed adenocarcinoma of a mixed subtype with papillary and bronchioloalveolar carcinoma. Epidermal growth factor receptor gene mutations were examined, and the 2 lesions shared an L858R mutation. Although we expected EGFR gene mutation analysis would help us distinguish the 2 lesions from each other, it was of little help. Disease history can be more important in evaluating multiple pulmonary cancers.
authors: Department of Thoracic Oncolog, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan.
authors: Kentaro
authors: K
authors: Yoshimoto
authors: Junji
authors: J
authors: Yoshida
authors: Genichiro
authors: G
authors: Ishii
authors: Mitsuyo
authors: M
authors: Nishimura
authors: Tomoyuki
authors: T
authors: Hishida
authors: Kanji
authors: K
authors: Nagai
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D004252:DNA Mutational Analysis; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D018193:Neoplasms, Complex and Mixed / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology* / Q000601:surgery; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: C512478:EGFR protein, human; D066246:ErbB Receptors