Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2022; 10(28): 10301-10309
Published online Oct 6, 2022. doi: 10.12998/wjcc.v10.i28.10301
One-stage resection of four genotypes of bilateral multiple primary lung adenocarcinoma: A case report
De-Yuan Zhang, Jing Liu, Yang Zhang, Jia-Yue Ye, Sheng Hu, Wen-Xiong Zhang, Dong-Liang Yu, Yi-Ping Wei
De-Yuan Zhang, Yang Zhang, Jia-Yue Ye, Sheng Hu, Wen-Xiong Zhang, Dong-Liang Yu, Yi-Ping Wei, Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Jing Liu, Department of Pathology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Zhang DY reviewed the relevant literature and participated in the drafting of the manuscript; Wei YP and Yu DL participated in the revision of the manuscript; Liu J, Zhang Y, Ye JY, Hu S, and Zhang WX participated in the information collection; Wei YP is the corresponding author; All authors read and approved the revised manuscript.
Supported by National Natural Science Foundation of China, No. 81860379 and No. 82160410.
Informed consent statement: A written informed consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Ping Wei, PhD, Chief Doctor, Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang 330006, Jiangxi Province, China. weiyip2000@hotmail.com
Received: May 22, 2022
Peer-review started: May 22, 2022
First decision: June 16, 2022
Revised: July 1, 2022
Accepted: August 25, 2022
Article in press: August 25, 2022
Published online: October 6, 2022
Processing time: 127 Days and 20.2 Hours
Abstract
BACKGROUND

The incidence of multiple primary lung cancer (MPLC) in China is 0.52%-2.45%. Most primary lung cancer cases have reported two lesions or three in rare cases. We report a rare case of bilateral simultaneous multiple primary lung adenocarcinoma of four different genotypes.

CASE SUMMARY

A 58-year-old woman was admitted to our hospital on June 29, 2021, and upon physical examination, four multiple pulmonary nodules were identified in both lungs. Further computed tomography (CT) images revealed the presence of ground glass nodules, predicted to be high-risk cancer lesions by artificial intelligence. With the guidance of three-dimensional reconstruction of preoperative CT images, the nodules were resected under thoracoscopy. Postoperative pathological investigation revealed that the nodule types were adenocarcinoma in situ, invasive alveolar adenocarcinoma, and microinvasive adenocarcinoma. The excised nodules were further sequenced using high-throughput sequencing (semiconductor sequencing method) of 26 lung cancer genes to confirm that the four lesions were not homologous. The patient was discharged on postoperative day 8, that is, on July 15, 2021. One month later, she returned to the hospital for follow-up and reexamination. Chest CT examination showed that she had recovered well, and no obvious exudation and effusion were found in both pleural cavities. Evaluation of postoperative pulmonary function showed that her forced vital capacity was 1.40 L (preoperative value, 2.27 L) and forced expiratory volume was 1.24 L (preoperative value, 2.23 L).

CONCLUSION

The surgical plan for multiple pulmonary nodules should be carefully considered. For carefully selected patients with concurrently occurring multiple lung nodules in both lungs, sublobectomy is a safe and feasible plan for concurrent bilateral resection of the lesions. Genetic sequencing is necessary for MPLC diagnosis and treatment.

Keywords: Multiple primary lung adenocarcinoma; Three-dimensional reconstruction; Sublobar resections; High-throughput sequencing; Case report

Core Tip: In this case, nodules in bilateral four lobes were resected simultaneously via video-assisted thoracic surgery. Postoperative pathological and genetic analyses revealed that the types of nodules were left upper lobe adenocarcinoma in situ [epidermal growth factor receptor (EGFR) exon 21], left lower lobe invasive adenocarcinoma (Erb-B2 receptor tyrosine kinase 2 exon 20 and tumor protein p53 exon 8), and right upper lobe microinvasive adenocarcinoma (EGFR exon 19), and right lower lobe microinvasive adenocarcinoma (EGFR exon 18). Genetic examination is of decisive significance in the identification of multiple lung cancers and metastatic cancers.