Ross Mitchell D, Biswas Roy Sreeja, Patil Pradnya D, Huang Jasmine L, Thawani Nitika, Drosten Ralph, Panchabhai Tanmay S
Department of Internal Medicine, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
Case Rep Pulmonol. 2018 Feb 20;2018:1718326. doi: 10.1155/2018/1718326. eCollection 2018.
Despite recent advances in screening methods, lung cancer remains the leading cause of cancer-related deaths worldwide. By the time lung cancer becomes symptomatic and patients seek treatment, it is often too advanced for curative measures. Low-dose computed tomography (CT) screening has been shown to reduce mortality in patients at high risk of lung cancer. We present a 66-year-old man with a 50-pack-year smoking history who had a right upper lobe (RUL) pulmonary nodule and left lower lobe (LLL) consolidation on a screening CT. He reported a weight loss of 45 pounds over 3 months, had recently been hospitalized for hyponatremia, and was notably cachectic. A CT of the chest showed a stable LLL mass-like consolidation and a 9 × 21 mm subsolid lesion in the RUL. Navigational bronchoscopy biopsy of the RUL lesion revealed squamous non-small cell lung cancer (NSCLC). Endobronchial ultrasound-guided transbronchial needle aspiration of the LLL lesion revealed small cell lung cancer (SCLC). The final diagnosis was a right-sided Stage I NSCLC (squamous) and a left-sided limited SCLC. The RUL NSCLC was treated with stereotactic radiation; the LLL SCLC was treated with concurrent chemotherapy and radiation. In patients with multiple lung nodules, a diagnosis of synchronous multiple primary lung cancers (MPLCs) is crucial, as inadvertent upstaging of patients with MPLC (to T3 and/or T4 tumors) can lead to erroneous staging, inaccurate prognosis, and improper treatment. Recent advances in the diagnosis of small pulmonary nodules via navigational bronchoscopy and management of these lesions dramatically affect a patient's overall prognosis.
尽管筛查方法最近有所进展，但肺癌仍然是全球癌症相关死亡的主要原因。当肺癌出现症状且患者寻求治疗时，往往病情已进展到无法采取治愈性措施的阶段。低剂量计算机断层扫描（CT）筛查已被证明可降低肺癌高危患者的死亡率。我们报告一名66岁男性，有50年包年吸烟史，在一次筛查CT中发现右上叶（RUL）肺结节和左下叶（LLL）实变。他报告在3个月内体重减轻了45磅，最近因低钠血症住院，且明显消瘦。胸部CT显示LLL有一个稳定的肿块样实变，RUL有一个9×21毫米的亚实性病变。RUL病变的导航支气管镜活检显示为鳞状非小细胞肺癌（NSCLC）。LLL病变的支气管内超声引导经支气管针吸活检显示为小细胞肺癌（SCLC）。最终诊断为右侧I期NSCLC（鳞状）和左侧局限性SCLC。RUL的NSCLC接受了立体定向放疗；LLL的SCLC接受了同步化疗和放疗。在有多发性肺结节的患者中，诊断为同步性多发性原发性肺癌（MPLC）至关重要，因为MPLC患者（误分期为T3和/或T4肿瘤）的意外分期可能导致错误的分期、不准确的预后和不恰当的治疗。通过导航支气管镜诊断小肺结节以及对这些病变的管理方面的最新进展极大地影响了患者的总体预后。
