Carmicheal Joseph, Johnson Kurtis C, Neilsen Beth K, Shonka Nicole, Zhang Chi, Baine Michael
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Case Rep Oncol. 2025 Feb 13;18(1):330-338. doi: 10.1159/000543770. eCollection 2025 Jan-Dec.
Non-small cell lung cancer (NSCLC) is the most common form of lung cancer and has a propensity to metastasize to the brain. It is incredibly difficult to distinguish between a primary brain lesions and a solitary metastasis from distant occult disease using current imaging techniques. Further, complications arise from the shifting paradigm in how medicine views NSCLC brain metastasis due to contemporary nonsurgical curative treatments and the recent increase in the number of multiple primary malignancy (MPM) diagnoses associated with NSCLC. There is a dearth of reports regarding synchronous double primary malignancies involving separate lung and brain pathologies. Importantly, understanding the underlying cancer etiology is necessary for efficacious treatment strategy.
A 65-year-old white male patient presented with node-positive NSCLC and a solitary intracranial lesion. The lung mass responded favorably to chemoradiotherapy while the brain lesion continued to progress despite stereotactic radiosurgery treatment. Subsequent resection of the brain lesion, conducted 8 months after initial presentation, surprisingly revealed a second primary cancer diagnosis of glioblastoma (GB). Unfortunately, despite revision of systemic therapeutic strategy, the patient continued to progress through treatment and ultimately died 16 months after the initial diagnosis.
Herein is the third report regarding synchronous double primary malignancies involving non-small cell lung cancer (NSCLC) and GB. This report of an assumed metastatic NSCLC patient with a solitary brain lesion, history of smoking, and COPD underscores the need for pathological confirmation of all new presentations of metastatic disease via biopsy and highlights the importance of including the possibility of a second primary in the differential diagnosis. Additional reports of NSCLC and synchronous solitary brain lesions are needed to further elucidate pertinent patient characteristics and better inform clinical decision making.
非小细胞肺癌（NSCLC）是肺癌最常见的形式，且易于转移至脑部。使用当前的成像技术，很难区分原发性脑病变和远处隐匿性疾病的孤立转移灶。此外，由于当代非手术治愈性治疗以及近期与NSCLC相关的多原发性恶性肿瘤（MPM）诊断数量的增加，医学对NSCLC脑转移的看法发生了转变，从而引发了并发症。关于同时发生的涉及肺部和脑部不同病理的双原发性恶性肿瘤的报道很少。重要的是，了解潜在的癌症病因对于有效的治疗策略至关重要。
一名65岁的白人男性患者，患有淋巴结阳性NSCLC和一个孤立的颅内病变。肺部肿块对放化疗反应良好，而尽管进行了立体定向放射外科治疗，脑部病变仍继续进展。在初次就诊8个月后对脑部病变进行了后续切除，令人惊讶的是，病理显示为胶质母细胞瘤（GB）的第二原发性癌症诊断。不幸的是，尽管修订了全身治疗策略，但患者在治疗过程中仍继续进展，最终在初次诊断后16个月死亡。
本文是关于非小细胞肺癌（NSCLC）和GB同时发生的双原发性恶性肿瘤的第三篇报道。该病例报告了一名疑似转移性NSCLC患者，有孤立性脑病变、吸烟史和慢性阻塞性肺疾病（COPD），强调了通过活检对所有新出现的转移性疾病进行病理确认的必要性，并突出了在鉴别诊断中考虑第二原发性癌症可能性的重要性。需要更多关于NSCLC和同时发生的孤立性脑病变的报道，以进一步阐明相关的患者特征，并为临床决策提供更好的依据。
