One-stage resection of four genotypes of bilateral multiple primary lung adenocarcinoma: A case report

Figure 1 Computed tomography image of pulmonary nodules. A: Left upper lung nodule (LS3), 11 mm in diameter; B: Left lower lung nodule (LS7), 20 mm × 14 mm × 10 mm; C: Upper right nodule (RS1), 8 mm in diameter; D: Lower right nodule (RS8), 8 mm in diameter. The orange arrow indicates the location of the nodule.

Figure 2 Location of pulmonary nodules in three-dimensional reconstruction. A: Upper lobe of left lung (LS3); B: Lower lobe of left lung (LS7); C: Upper lobe of right lung (RS1); D: Lower lobe of right lung (RS8); E: Three-dimensional imaging projection of pulmonary nodule on the pleura.

Figure 3 The left side of the image is a computed tomography image. The red arrow indicates the location of the nodule. The upper right side indicates a low-power microscopic pathological image, and the lower right side indicates a high-power microscopic pathological image. A: The left upper pulmonary nodule is an adenocarcinoma in situ, with adherent growth and obvious cell atypia; B: The left lower lung nodule is an acinar adenocarcinoma with glandular arrangement, invasive growth, significant atypia of cancer cells, and proliferation of interstitial fibrous tissue; C and D: The right upper and right lower nodules are microinvasive adenocarcinoma. The cancer cells adhere to the wall; the cell atypia is significant; and the focus shows invasive growth.

Figure 4 Depiction of the mutations detected in the present case. A: Mutation detected in the upper lobe of the left lung cancer [epidermal growth factor receptor (EGFR) exon 21 c.2573T>G p.L858R]; B and C: Mutation detected in the lower lobe of the left lung cancer (1. Erb-B2 receptor tyrosine kinase 2 exon 20 c.2310_2311i nsGCATAC GTGATG p. E770_A77 1insAYVM, 2. Tumor protein p53 exon 8 c.796G>A p.G266R); D: Mutation detected in the upper lobe of the right lung cancer (EGFR Exon 19 c.2238_2252 delATTAAG AGAAGCA AC p.L747_T751 del); E: Mutation detected in the lower lobe of the right lung cancer (EGFR exon 18 c.2156G>C p.G719A).