Kim Jee Hyuk, Park Seung Yong, Park Seoung Ju, Chung Myoung Ja, Lee Heung Bum
Department of Internal Medicine, Research Center for Pulmonary Disorders Department of Pathology, Chonbuk National University Medical School, Jeonju, South Korea.
Medicine (Baltimore). 2017 Dec;96(48):e8923. doi: 10.1097/MD.0000000000008923.
The documented incidence of multiple primary lung cancer has increased as a result of the widespread use of early detection tools. We report the successful surgical treatment of a case who had consecutive metachronous adenocarcinoma and squamous cell carcinoma of the lung after successful treatment for small cell carcinoma of the lung.A 73-year-old man underwent a routine health check-up. Computed tomography showed ground-glass opacity in the upper lobe of the right lung, which was diagnosed as small cell carcinoma. Twenty-nine months after concurrent chemoradiotherapy for the carcinoma, which was in complete remission, a nodule was detected in the apical segment of the right upper lobe. Histopathologically, the tumor was diagnosed as poorly differentiated adenocarcinoma. The second metachronous adenocarcinoma was completely removed by right upper lobectomy with lymph node dissection. Seventeen months later, the patient underwent left upper lobectomy with lymph node dissection and received 4 cycles of adjuvant chemotherapy for another moderately differentiated squamous cell carcinoma.
This case highlights the need for continuous screening for metachronous lung cancer following the successful treatment of primary lung cancer, even small cell carcinoma, to identify patients who could benefit from curative surgery.
由于早期检测工具的广泛使用，有记录的多原发性肺癌发病率有所上升。我们报告了一例成功接受手术治疗的病例，该患者在成功治疗肺小细胞癌后，先后发生了异时性肺腺癌和肺鳞状细胞癌。一名73岁男性接受了常规健康检查。计算机断层扫描显示右肺上叶有磨玻璃影，诊断为小细胞癌。该癌症同步放化疗后29个月，完全缓解，右肺上叶尖段发现一个结节。组织病理学检查诊断该肿瘤为低分化腺癌。通过右上叶切除加淋巴结清扫术将第二个异时性腺癌完全切除。17个月后，患者接受了左上叶切除加淋巴结清扫术，并因另一个中分化鳞状细胞癌接受了4个周期的辅助化疗。
该病例强调，即使是小细胞癌，在原发性肺癌成功治疗后，也需要持续筛查异时性肺癌，以确定能从根治性手术中获益的患者。
