The Comprehensive Cancer Center, Affiliated Drum Tower Hospital, Medical School, Nanjing University and Clinical Cancer Institute of Najing University, Nanjing, China.
Department of Pathology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, Nanjing, China.
Thorac Cancer. 2023 May;14(14):1316-1319. doi: 10.1111/1759-7714.14864. Epub 2023 Mar 25.
One year following bladder cancer surgery, a 65-year-old man had computed tomography (CT) that revealed bilateral pulmonary nodules. Pulmonary wedge resections were performed after the nodules were found to grow in follow-up. Unusually, we found that these two lesions were not homologous, nor were they metastases from prior bladder cancer, and therefore, synchronous double primary lung cancer (sDPLC) was diagnosed. The immunohistochemical findings excluded the possibility of bladder cancer metastasis, but could not determine whether they were from the same source. Next generation sequencing (NGS) supported the diagnosis sDPLC because they amply demonstrated the two sources' distinct origins. Finally, after discussion with pathologists, this patient was diagnosed as small cell lung carcinoma (SCLC) and received postoperative EP chemotherapy. We also documented a few rather uncommon alterations that might serve as a foundation for further investigation. This case suggests that in addition to immunohistochemical, NGS is also helpful to clarify the etiology and refine the pathological classification of tumors, which has guiding significance for the establishment of precise diagnosis and optimal treatment.
一名 65 岁男性膀胱癌手术后 1 年，行计算机断层扫描（CT）检查发现双侧肺结节。在随访中发现结节增大后进行了肺楔形切除术。不同寻常的是，我们发现这两个病变并非同源，也不是来自先前膀胱癌的转移，因此诊断为同步双原发性肺癌（sDPLC）。免疫组化结果排除了膀胱癌转移的可能性，但不能确定它们是否来自同一来源。下一代测序（NGS）支持 sDPLC 的诊断，因为它们充分证明了两个来源的不同起源。最后，与病理学家讨论后，该患者被诊断为小细胞肺癌（SCLC），并接受术后 EP 化疗。我们还记录了一些较为罕见的改变，这些改变可能为进一步研究提供基础。该病例提示，除了免疫组化，NGS 还有助于明确肿瘤的病因和细化病理分类，对建立准确的诊断和优化治疗具有指导意义。
