Three different subtypes of lung cancer appear in one patient, what's going on?

The occurrence of lung cancer is closely related to smoking, chronic obstructive pulmonary disease, environmental pollution and other factors

What is multiple primary lung cancer (MPLC)? Multiple primary lung cancer (MPLC) refers to two or more primary lung cancers that occur simultaneously or sequentially in different parts of one or both lungs of the same patient

Multiple primary lung cancer (MPLC) is more common in patients with a history of smoking and chronic obstructive pulmonary disease

What is the experience of suffering from three different types of lung cancer?

A 76-year-old man was found to have a lung mass in December 2018

CT examination revealed a mass in the patient's right upper lobe and a mass-like lesion in the right lower lobe

However, the patient refused surgical resection.

However, in June 2020, the mass in the lower lobe of the right lung, which had been followed up until now, began to grow, and continued to grow after five months, and new nodules appeared around it

Figure 1.
CT scan results performed at different time points

Five months after the patient was diagnosed with squamous cell carcinoma of the lung, a new nodule developed in the lower lobe of the left lung, and this nodule continued to grow in size over the next two months of observation
.

Through bronchoscopy biopsy, it was found that the lung tumor was small cell lung cancer, and the clinical stage was limited-stage small cell lung cancer
.

The patient still refused surgery, so concurrent chemoradiotherapy, namely etoposide and carboplatin, was performed
.

Figure 2.
Histopathological comparison of three different lung cancer subtypes

Inspiration and discussion

Judging from the diagnosis time of the patient in the case, lung adenocarcinoma and lung squamous cell carcinoma may have occurred at the same time, and small cell lung cancer appeared 29 months later, which is a metachronous multiple primary lung cancer
.

When a new nodule mass appears in the lungs, a biopsy is used to determine the type of pathology, so that a more appropriate method can be selected for later treatment
.

During the treatment or follow-up period, if the tumor lesions continue to grow, it is necessary to consider whether the existing treatment plan can effectively control the tumor.
At this time, it is necessary to perform a pathological biopsy
.

Once the tumor subtype changes, such as from lung adenocarcinoma to small cell lung cancer, existing treatments may be completely ineffective
.

Pathological biopsy, and simultaneous genetic testing, can find the correct treatment
.

The patient quit smoking after his first lung cancer diagnosis, but he still works in the parking lot every day
.

It is difficult to say whether the culprit of the patient's multiple primary lung cancers is smoking or car exhaust exposure, and it may be caused by the combined effect of the two
.

Although the patient has no family history, the patient's wife was also diagnosed with stage IV lung adenocarcinoma in August 2021, and her wife also works in the parking lot
.

From this point of view, the closed environment of the parking lot and car exhaust may be a pathogenic factor leading to lung cancer
.

Therefore, we remind people working in similar environments to pay attention to safety and protection
.

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Reference: Choi HS, et al.
Triple primary lung cancer: a case report.
BMC Pulm Med.
2022.

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