Meral GÜLHAN, Nalan OGAN, Tevfik KAPLAN, Egemen AKINCIOĞLU, Handan DOĞAN, Ayşe BAHA

Coexistence of Three Malignancies: Two Different Lung Cancers Synchronous with Lymphoma

Epithelial tumors synchronous with hematologic malignancies are very rare. The hystopathologic type and stage of synchronous tumors are very important for prognosis. A 77-year-old male patient was diagnosed with lymphoma after an excisional biopsy was taken from the retroauricular region. Positron emission tomography, performed for lymphoma staging, revealed a positive solid nodule (SUVmax: 24.3) in the posterobasal segment of the right lower lobe and a negative subsolid nodule in the anterior segment of the upper lobe. Right lower lobectomy and wedge resection for subsolide nodule in the upper lobe were performed. Histopathological examination revealed mildly differentiated squamous cell carcinoma for the solid nodule and mildly differentiated adenocarcinoma with lepidic pattern for the subsolid nodule. The patient was treated for only lymphoma according to the decision of the tumor board, and his condition is stable for 1 year without any evidence of lung cancer recurrence. This case presents the treatment approach and the fact that triple synchronic malignant cases are rare in the literature.

PDF

___

1. van Leeuwen FE, Travis LB. Second cancers. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia: Lippincott Williams&Wilkins; 2001. p. 2939-64.
2. Jung EJ, Lee JH, Jeon K, Koh WJ, Suh GY, Chung MP, et al. Treatment outcomes for patients with synchronous multiple primary non-small cell lung cancer. Lung Cancer 2011;73(2):237-42.
3. Long NM, Smith CS. Causes and imaging features offalse positives and false negatives on F-PET/CT in oncologic imaging. Insights Imaging 2011;2(6):679-98.
4. Ichihara E, Tabata M, Takigawa N, Sato Y, Kondo E, Aoe M, et al. Synchronous pulmonary MALT lymphoma and pulmonary adenocarcinoma after metachronous gastric MALT lymphoma and gastric adenocarcinoma. J Thorac Oncol 2008;3(11):1362-3.
5. Rothenburger M, Semik M, Hoffmeier A, Baba H, Kamanabrou D, Roos N, et al. Coexistence of nonHodgkin's lymphoma and non-small cell lung carcinoma: diagnosis and treatment. Thorac Cardiovasc Surg 2002;50(1):59-61.
6. Zheng JX, Li XZ, Xiang RL, Gao Z. Synchronous primary pulmonary lymphoma presenting with pulmonary adenocarcinoma: A case report and literature review. Indian J Cancer 2015;52 Suppl 1:e37-40.
7. van Rens MT, Zanen P, Brutel de La Rivière A, Elbers HR, van Swieten HA, van Den Bosch JM. Survival in synchronous vs. single lung cancer: upstaging better reflects prognosis. Chest 2000;118(4):952-8.
8. Uçgun I, Akçayir Sahin I, Metintaş M, Alataş F, Erginel S, Dündar E. Synchronous primary lung cancers: due to the four cases. Tuberk Toraks 2004;52:262-7.
9. Detterbeck FC, Postmus PE, Tanoue LT. The stage classification of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143(5 Suppl):e191S-e210S.
10. Liu M, He W, Yang J, Jiang G. Surgical treatment of synchronous multiple primary lung cancers: a retrospective analysis of 122 patients. J Thorac Dis 2016;8(6):1197-204