Gordon Noah, Gratza Danielle, Asado Nahren, Raad Wissam, Alraiyes Abdul
Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, USA.
Pathology, Advocate Lutheran General Hospital, Park Ridge, USA.
Cureus. 2025 Jun 10;17(6):e85729. doi: 10.7759/cureus.85729. eCollection 2025 Jun.
Pulmonary nodules are frequently identified on radiographic evaluation, often due to lung cancer screening with low-dose computed tomography, an increasingly utilized technology in high-risk patients, or incidentally discovered with alternative imaging modalities. Although most nodules are benign, lung cancer remains difficult to treat, particularly in its late stages, which are more prone to metastasis. We present a case of a 71-year-old female, a former smoker, who was evaluated in the emergency department for chronic cough and dyspnea. On evaluation, computed tomography pulmonary angiography incidentally revealed three distinct pulmonary nodules. Following evaluation by our multidisciplinary team, robot-assisted bronchoscopy (RAB) was performed, revealing three distinct primary malignancies: well-differentiated adenocarcinoma with KRAS mutation, poorly differentiated adenocarcinoma with EGFR mutation, and a well-differentiated carcinoid tumor. The patient underwent staged surgical resections for curative intent. This case underscores the limitations of strict adherence to existing pulmonary nodule guidelines, such as those from the Fleischner Society, which, in this instance, could have led to inaccurate staging and palliative systemic therapy. It also highlights the critical value of considering biopsy of multiple nodules, now increasingly feasible with advanced technologies such as RAB. Early and accurate characterization of each lesion allowed for appropriate staging and individualized, potentially curative treatment.
肺结节在影像学评估中经常被发现，这通常是由于对高危患者越来越多地使用低剂量计算机断层扫描进行肺癌筛查，或者是在采用其他成像方式时偶然发现的。尽管大多数结节是良性的，但肺癌仍然难以治疗，尤其是在晚期，晚期更容易发生转移。我们报告一例71岁女性病例，该患者曾吸烟，因慢性咳嗽和呼吸困难在急诊科接受评估。评估时，计算机断层扫描肺血管造影偶然发现三个不同的肺结节。经我们的多学科团队评估后，实施了机器人辅助支气管镜检查（RAB），发现了三种不同的原发性恶性肿瘤：具有KRAS突变的高分化腺癌、具有EGFR突变的低分化腺癌和高分化类癌肿瘤。该患者接受了分期手术切除以达到治愈目的。该病例强调了严格遵循现有肺结节指南（如弗莱施纳学会的指南）的局限性，在这种情况下，可能会导致分期不准确和姑息性全身治疗。它还突出了对多个结节进行活检的关键价值，如今借助RAB等先进技术，对多个结节进行活检越来越可行。对每个病变进行早期和准确的特征描述有助于进行适当的分期和个体化的、可能治愈性的治疗。
