Lee Yong Chul, Park Yun Ji, Gang Su Jin, Chung Myung Ja, Kim So Ri
From the Department of Internal Medicine and Research Center for Pulmonary Disorders (YCL, YJP, SJG, SRK); Department of Pathology, Chonbuk National University Medical School (MJC); and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, South Korea (YCL, MJC, SRK).
Medicine (Baltimore). 2015 May;94(17):e770. doi: 10.1097/MD.0000000000000770.
Multiple or second primary lung cancers can develop at any sites in the lung with same or different histologic types, synchronously and/or metachronously. In case of metachronous occurrence of the second primary lung cancer, it is easy to confuse with the primary lung cancer as a recurrence of precedent lung malignancy treated successfully or metastasis. Previous reports have demonstrated that majority of the second primary lung malignancies have same histologic types regardless of their developing time and location. However, the repeated occurrence of the second primary lung malignancy, in particular with the different histologic features, is a very rare condition.A 62-year-old male who had past history of squamous cell carcinoma treated with surgery and adjuvant chemotherapy and the recurrence of lung malignancy on the trachea, which was also resected successfully visited our hospital due to blood tinged sputum. Evaluation using bronchoscopy and chest computed tomography revealed the tracheal mass looked similar grossly to the previous recurred tracheal mass that was resected surgically. Unexpectedly, the newly developed tracheal mass was confirmed as small cell lung cancer, the different histologic type from previous ones.In this report, we describe an interesting case of subsequent occurrence of second primary lung cancers showing histologic shifting at different sites in trachea, suggesting that it is important for physician to make an effort to identify the histologic characteristics of second primary lung cancers for the correct and adequate treatment no matter what they exhibit similar gross morphology.
多发性或第二原发性肺癌可发生于肺内的任何部位，组织学类型相同或不同，可同时和/或异时发生。在第二原发性肺癌异时发生的情况下，很容易与作为先前成功治疗的肺恶性肿瘤复发或转移的原发性肺癌相混淆。既往报道显示，大多数第二原发性肺恶性肿瘤无论其发生时间和部位如何，组织学类型相同。然而，第二原发性肺恶性肿瘤的反复发生，尤其是具有不同组织学特征的情况，是非常罕见的。一名62岁男性，有鳞状细胞癌手术及辅助化疗史，气管出现肺恶性肿瘤复发，也成功切除，因痰中带血来我院就诊。支气管镜检查和胸部计算机断层扫描评估显示，气管肿物大体外观与先前手术切除的复发气管肿物相似。出乎意料的是，新出现的气管肿物被确诊为小细胞肺癌，与先前的组织学类型不同。在本报告中，我们描述了一例有趣的第二原发性肺癌异时发生的病例，其在气管不同部位出现组织学转变，提示医生无论第二原发性肺癌外观形态如何相似，都应努力识别其组织学特征，以便进行正确和充分的治疗。
