A case of multiple synchronous lung adenocarcinomas with differing EGFR mutations
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CASE REPORT
A case of multiple synchronous lung adenocarcinomas with differing EGFR mutations Hideomi Hasegawa • Hideki Kimura • Masato Shingyoji • Makiko Itami • Akinobu Araki • Sana Yokoi • Hajime Kageyama • Toshihiko Iizasa
Received: 10 December 2012 / Accepted: 4 March 2013 Ó The Japan Society of Clinical Oncology 2013
Keywords Lung cancer Epidermal growth factor receptor (EGFR) Surgery Adenocarcinoma
carcinoma (BAC) and adenocarcinoma [1]. The multifocality of lung nodules may be due to either the dissemination of malignant cells from a single primary tumor (intrapulmonary spread) or synchronous development of multifocal independent lesions. The distinction of intrapulmonary metastases from independent primary tumors is of great clinical importance as it influences the staging and therapeutic strategy [2, 3]. We report a case of four synchronous lung adenocarcinomas in the lungs. Gene mutation analysis showed these tumors to be independent, genetically differing lesions with differing epidermal growth factor receptor (EGFR) mutations. Molecular analysis in addition to histological diagnosis of the clonal relationships between multiple lesions helps in the differentiation between metastases and multifocal lung cancers [4].
Introduction
Case presentation
Lung adenocarcinoma is one of the leading causes of death in Japan. Advances in high-resolution computed tomography (CT) and the prevalence of CT screening for lung cancer have increased the detection of multiple solid and ground-glass opacity (GGO) nodules, which are often atypical adenomatous hyperplasia (AAH), bronchioloalveolar
A 55-year-old woman with a history of smoking (Brinkman index: 500) and breast cancer was referred to our hospital for abnormal shadows in the upper lobes of both lungs (Fig. 1). Bronchoscopic examination with endobronchial ultrasound trans-bronchial needle aspiration (EBUSTBNA) [5] and positron emission tomography indicated lung cancer of both upper lobes without lymph node involvement or distant metastasis. Double primary lung cancer was diagnosed in both lungs, and surgery was performed. The first operation was performed on the left lung, and the right lung procedure followed 2 months later. The left S1 ? 2b tumor, which measured up to 2.8 cm in diameter, was adenocarcinoma with mixed subtype (non-mucinous BAC [ papillary adenocarcinoma: Fig. 2). In the course of a left upper lobectomy, S6 partial resection was also performed because a small nodule, which had not
Abstract We report a case of four synchronous lung cancers, each with a different epidermal growth factor receptor (EGFR) mutation in the tyrosine kinase domain. Bilateral double lung cancer was diagnosed clinically, and a left upper lobectomy and partial left S6 resection were performed. Right S1 segmental resection was performed later. Pathological examination revealed three lung adenocarcinomas in the left lung (S1 ? 2, S3, and S6) and one in the right. Three different mutations of EGFR were identified with the polymerase chain reaction and direct sequenc
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