title: A case of synchronous double primary lung cancer presenting with pleomorphic carcinoma and adenocarcinoma.
abstract: BACKGROUND
  Recently, synchronous multiple lung cancer (SMPLC) has sometimes been detected as a result of improved radiological imaging, although the occurrence of SPMLC is still rare. To the best of our knowledge, there have been no reported cases of with synchronous double primary lung cancer presenting with pleomorphic carcinoma and adenocarcinoma. We herein report such a case.
  
  
  METHODS
  A 64-year-old male was referred to our institution for an abnormal shadow in the apex of the left lung in April 2012. CT revealed 2 nodules that measured 15 mm in the left S(1+2b) and 20 mm in the left S3c. We suspected that the lesions were malignant, although the diagnosis could not be confirmed by transbronchial lung biopsy of the lesions. Therefore, we performed the left upper lobectomy. The results of the pathological examination of the nodule in S3c showed adenocarcinoma of pT1aN0M0, stage IA. The nodule in S(1+2b) was found to be pleomorphic carcinoma, pT1aN0M0, stage IA. In November 2012, the patient underwent an esophagogastroduodenoscopy because of anemia. The image findings showed a gastric ulcer on the greater curvature of his stomach. The pathological examination of the biopsy specimen from the ulcer revealed the metastatic cancer from pleomorphic carcinoma. In addition, abdominal CT revealed bilateral adrenal metastasis. Although the patient received chemotherapy, it was not effective. It was difficult to continue the chemotherapy because his performance status worsened. He died in May 2013.
  
  
  CONCLUSIONS
  The present case was associated with a poor prognosis, even though the pathological stage of each tumor was stage IA. The prognosis of SMPLC may be associated with the histologic type, although the prognosis of SMPLC remains unclear due to its rarity.
authors.affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Taira
authors.affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kawabata
authors.affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Ichi
authors.affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kushi
authors.affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Yohena
authors.affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kawasaki
authors.affiliation: Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Division of Pathology and Cell Biology, Graduate School and Faculty of Medicine, University of the Ryukyus, Nishihara, Japan.
authors.forename: Seiya
authors.initials: S
authors.lastname: Kato
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis* / Q000628:therapy