Erika Simmerman DO, Christy Stover DO, Andrew Simmerman BS, Zhonglin Hao, Daniel Kleven and Carsten Schroeder
As a result of improved cancer detection and greater life expectancy, diagnoses of synchronous primary lung cancers are becoming more common. We present a unique example of three distinctly different histologic tumors in one lobe. A 63 year-old female with suspicious lung nodules opted for short term CT-scan follow-up for two separate right upper lobe (RUL) nodules. In the two months interval a new subcentimeter RUL nodule developed. All three nodules were hypermetabolic on PET-CT. After wedge resection, that revealed a large cell neuroendocrine carcinoma, a formal right upper lobectomy was performed. Pathology revealed: a Sarcomatoid carcinoma, an adenocarcinoma with intracellular mucine, and a large cell neuroendocrine caricnoma. Interestingly, the third tumor was discovered during post-surgical tumor board discussion requesting a reexamination of the lobectomy specimen, emphasizing the importance of multidisciplinary review. This case might indicate that such synchronicities may occur at a greater rate than currently estimated.
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