Haratake Naoki, Takenoyama Mitsuhiro, Edagawa Makoto, Shimamatsu Shinichiro, Toyozawa Ryo, Nosaki Kaname, Hirai Fumihiko, Yamaguchi Masafumi, Taguchi Kenichi, Seto Takashi, Ichinose Yukito
Department of Thoracic Oncology, National Kyushu Cancer Center, Fukuoka 811-1395, Japan.
Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
J Thorac Dis. 2018 Apr;10(4):E255-E259. doi: 10.21037/jtd.2018.03.105.
We describe a 77-year-old Japanese woman who presented with three nodule shadows in three different lobes of the right lung, without evidence of lymph node metastasis or distant metastasis. All three tumors were surgically resected. The pathological diagnosis was synchronous multiple primary lung cancer: pT2aN0M0, pStageIB. Based on a differing epidermal growth factor receptor (EGFR) mutation status, no lymph node metastasis, and no distant metastasis, the tumors were characterized as synchronous triple primary rather than intrapulmonary metastases. At eight months after surgery, a new lesion emerged in the right lower lobe. Given that the most advanced tumor had an EGFR del-19 mutation, the patient was orally administered afatinib. Since then, the treatment response of the patient has been assessed as stable disease (SD) for about two years. This is a very rare case of resected triple synchronous primary lung cancer on the same lung side in which the lesions all had a different mutation status, and this report highlights the clinical utility of surgical resection of multifocal lung nodules without lymph node metastasis or distant metastasis in order to optimize therapy for patients with known driver mutations.
我们描述了一位77岁的日本女性，她在右肺的三个不同叶出现了三个结节阴影，无淋巴结转移或远处转移的证据。所有三个肿瘤均接受了手术切除。病理诊断为同步性多原发性肺癌：pT2aN0M0，p分期为IB期。基于不同的表皮生长因子受体（EGFR）突变状态、无淋巴结转移和无远处转移，这些肿瘤被特征化为同步性三原发性肿瘤而非肺内转移瘤。术后八个月，右下叶出现了一个新病变。鉴于最晚期的肿瘤具有EGFR del-19突变，该患者口服了阿法替尼。从那时起，患者的治疗反应被评估为疾病稳定（SD）约两年。这是同一肺侧切除的同步性三原发性肺癌的非常罕见的病例，其中病变均具有不同的突变状态，本报告强调了在无淋巴结转移或远处转移的情况下对多灶性肺结节进行手术切除以优化对已知驱动基因突变患者的治疗的临床实用性。
