Synchronous multiple lung cancers with hilar lymph node metastasis of small cell carcinoma: A case report

Figure 1 Chest radiograph (frontal view). Nodular shadows associated with the surrounding tightening are observed in the right upper lung field (arrow).

Figure 2 Chest computed tomography findings. A: Chest computed tomography (CT) using the lung window showing slightly increased density in the periphery (black arrow); B: Primary lesion detected using the lung window. An irregularly shaped mass measuring 25 mm is observed in the right upper pulmonary lobe (black arrow); C: Chest CT using the mediastinal window revealing enlarged lymph nodes in the right hilar region (white arrow).

Figure 3 Fluorodeoxyglucose positron emission tomography findings. Fluorodeoxyglucose uptake with a maximum standardized uptake value of approximately 5.0 is observed in the right upper lung field (up arrow) and right hilar region (down arrow).

Figure 4 Resected specimen findings. In addition to the primary lesion, another lesion with a grayish-white area is noted on the cranial side (white arrows).

Figure 5 Histopathological findings. A: Primary lesion in the right upper pulmonary lobe. The staining results indicate squamous cell carcinoma [hematoxylin-eosin (HE) staining, Scale bar: 50 μm]; B: Primary lesion in the right upper pulmonary lobe. The immunohistochemical staining results are positive for p40 (Scale bar: 20 μm); C: A lesion located on the cranial side of the primary lesion. The staining results indicate microinvasive adenocarcinoma (HE staining, Scale bar: 50 μm); D: Lobar bronchial lymph node (#12u). The staining results indicate small cell carcinoma (HE staining, Scale bar: 50 μm).