Background: In order to raise discussion on the management of multiple pulmonary nodules, we describe the unusual case of a 70 years old man affected by three synchronous NSCLC’s Methods: Past medical history was significant for 40 pack year smoking, hypertension, COPD, type II diabetes mellitus and gout arthropathy, previous gastric resection for peptic ulcer. An incidental chest CT scan revealed: 1) a 0,5 cm very small non calcified nodule in the middle lobe; 2) a 2.5 cm nodule in the apical segment of the right upper lobe presenting irregular margins, a pleural tail and a mixed density; 3) a 2.5 cm nodule, solid and rounded, with irregular borders, in the posterior segment of the right lower lobe; 4) a 2 cm nodule, solid and irregular, located in the apical-dorsal segment of the left upper lobe. Trans-bronchial biopsy of the right upper lobe nodule was positive for bronchiolar-alveolar carcinoma , PET showed ipermetabolic activity in correspondence of the three bigger nodules. The clinical staging was T1N0M1 (Stage IV). Results: Considering the impossibility to discriminate among primary or metastatic lesions on the basis of fine needle biopsies, through mid sternotomy the wedge resection of the nodules was uneventfully performed. Histology and immunohistochemistry provided diagnosis of synchronous right lung adenocarcinomas and left lung neuroendocrine carcinoma. The 0,5 cm nodule was benign. Pathological staging was pT1NXMX. After 24 months the patient is disease free. Conclusions: When radiological imaging supports the possibility of multiple synchronous NSCLC’s, an aggressive surgical approach is recommended not to exclude patients from effective cure.
Case Report: Lesson learned on a case of three synchronous NSCLC‘S
ZOMPATORI, MAURIZIO;MATTIOLI, SANDRO
2009
Abstract
Background: In order to raise discussion on the management of multiple pulmonary nodules, we describe the unusual case of a 70 years old man affected by three synchronous NSCLC’s Methods: Past medical history was significant for 40 pack year smoking, hypertension, COPD, type II diabetes mellitus and gout arthropathy, previous gastric resection for peptic ulcer. An incidental chest CT scan revealed: 1) a 0,5 cm very small non calcified nodule in the middle lobe; 2) a 2.5 cm nodule in the apical segment of the right upper lobe presenting irregular margins, a pleural tail and a mixed density; 3) a 2.5 cm nodule, solid and rounded, with irregular borders, in the posterior segment of the right lower lobe; 4) a 2 cm nodule, solid and irregular, located in the apical-dorsal segment of the left upper lobe. Trans-bronchial biopsy of the right upper lobe nodule was positive for bronchiolar-alveolar carcinoma , PET showed ipermetabolic activity in correspondence of the three bigger nodules. The clinical staging was T1N0M1 (Stage IV). Results: Considering the impossibility to discriminate among primary or metastatic lesions on the basis of fine needle biopsies, through mid sternotomy the wedge resection of the nodules was uneventfully performed. Histology and immunohistochemistry provided diagnosis of synchronous right lung adenocarcinomas and left lung neuroendocrine carcinoma. The 0,5 cm nodule was benign. Pathological staging was pT1NXMX. After 24 months the patient is disease free. Conclusions: When radiological imaging supports the possibility of multiple synchronous NSCLC’s, an aggressive surgical approach is recommended not to exclude patients from effective cure.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
