title: Long-term disease-free survival of a patient with synchronous bilateral lung adenocarcinoma displaying different EGFR and C-MYC molecular characteristics.
abstract: The main difficulty with multiple lung tumors is distinguishing synchronous and metachronous lesions from second independent primary tumors, particularly when dealing with the same histologic type. Challenging diagnostic hurdles may explain, at least in part, the extremely variable (0%-79%) 5-year survival rate. We present a case report of a patient with synchronous primary adenocarcinoma treated with surgery that exhibited different EGFR gene status, with an exon 19 mutation in the adenocarcinoma of the left upper lobe that was absent in the right upper lobe. Further, specific EGFR and C-MYC amplification events were associated only with the EGFR-mutated lesion. According to an independent evolution theory, these events were classified as early stage, and the patient is still alive and free of disease 70 months after surgery. Molecular evaluation was an important tool to support the diagnosis of synchronous primary adenocarcinoma, which had not been possible with the application of Martini-Melamed criteria.
authors: Anatomic Pathology Unit, San Camillo-Forlanini Hospital, Rome, Italy. Electronic address: pgraziano@scamilloforlanini.rm.it.
authors: Paolo
authors: P
authors: Graziano
authors: Thoracic Surgery Unit, San Camillo-Forlanini Hospital, Rome, Italy.
authors: Giuseppe
authors: G
authors: Cardillo
authors: Medical Oncology Unit, San Camillo-Forlanini Hospital, Rome, Italy.
authors: Andrea
authors: A
authors: Mancuso
authors: Department of Cardiovascular and Respiratory Sciences, San Camillo-Forlanini Hospital, Rome, Italy.
authors: Gregorino
authors: G
authors: Paone
authors: Anatomic Pathology Unit, San Camillo-Forlanini Hospital, Rome, Italy.
authors: Rita
authors: R
authors: Gasbarra
authors: 1st Oncological Pulmonary Unit, San Camillo-Forlanini Hospital, Rome, Italy.
authors: Filippo
authors: F
authors: De Marinis
authors: Anatomic Pathology Unit, San Camillo-Forlanini Hospital, Rome, Italy.
authors: Alvaro
authors: A
authors: Leone
mesh_terms: D000230:Adenocarcinoma / Q000235:genetics* / Q000601:surgery; D000368:Aged; D018572:Disease-Free Survival; D005091:Exons; D018773:Genes, erbB-1; D016259:Genes, myc; D006801:Humans; D008175:Lung Neoplasms / Q000235:genetics* / Q000601:surgery; D008297:Male; D009154:Mutation; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000235:genetics* / Q000601:surgery