We instant a patient with three lung cancers compos of adenosquamous carcinoma.

We instant a patient with three lung cancers compos of adenosquamous carcinoma, adenocarcinoma, and squamous solitary abode; squalid carcinoma. Marked response was obtained in squamous lonely dwelling carcinoma components following chemotherapy, on the contrary not in adenocarcinoma components. uniform multiple malignant lesions of the lung might have a chance to be controll through a combination of chemotherapy and surgery

In newly come years, as a result of improvement in the diagnosis and the therapy for primary lung cancer, the number of patients suffering from multiple lung cancers has increased. We describe a patient with three simultaneous lung cancers compos of adenosquamous carcinoma, adenocarcinoma, and squamous small room carcinoma, which was successfully treated with neoadjuvant chemotherapy.

CASE REPORT

A 63-year-old, apparently healthy man who had a routine medical checkup in October 1989 showed a rise in carcinoembryonic antigen (CEA) plain Chest radiograph then revealed a mass in the right lung He was admitted to the hospital for further studious mood free of symptoms in March 1990 His family history was positive for lung cancer in his brother. He had an 80-pack-year history of cigarette smoking. terminates of physical examination were within normal limits. Laboratory data were noncontributory object for the CEA value, which was 181 ng/ml At hospital admission, besides the known mass in the right lower lobe that measured 60 mm in diameter, a inferior mass 20 mm in diameter was bring to lighted in the left lower lobe. Flexible fiberoptic bronchoscopy with brushing cytologic studies revealed squamous small cavity carcinoma in both the larger tumor in the right lower lobe and the smaller tumor in the left lower lobe. Neoadjuvant treatment prior to surgery was performed. Three courses of chemotherapy were administered consisting of cisplatin, 100 mg/[msup2]; etoposide, 240 mg/[msup2]; and vindesine, 4 mg/[msup2] Chest comput tomography then confirmed an 80 percent reduction of the right mass (partial response) with a disappearance of the left mass (complete response) His serum CEA malign to 5.3 ng/ml. onward July 13, the patient underwent right lower lobectomy with hilar and mediastinal lymphadenectomy. There was no evidence of mediastinal lymph node metastasis. The histologic report revealed adenosquamous carcinoma compos of a tubular adenocarcinoma and a low-differentiated squamous carcinoma being predominant, barely part of which consisted of degenerated cancer enclosed spaces following preoperative chemotherapy. The patient's postoperative course was monotonous He refused any further surgical intervention in the left lung When he was discharged from the hospital in succession August 21, his serum CEA on a level was 3.4 ng/ml. single in kind and a half months after hospital discharge, he agreed to an operation when the follow-up examination showed enlargement of a left mass, in spite of serum CEA horizontal remaining low at 3.7 ng/ml upon October 12, a left thoracotomy was performed and revealed in addition to the known tumor in S8 measuring 12 mm in diameter, another tiny, hard separate mass just in a less degree than the pleura. A frozen section of the latter revealed an adenocarcinoma. A partial resection of the left lower lobe, including the couple masses, and hilar lymphadenectomy were carried public Microscopic examination demonstrated that the mass recognized preoperatively was a moderately differentiated squamous confined apartment carcinoma with a slight degeneration of the cancer enclosed spaces resulting from preoperative chemotherapy. The tiny mass that was plant accidentally was a papillary adenocarcinoma that showed no imports of the therapy. The surgical margins and hilar lymph nodes were independent of disease. The patient's postoperative course was monotonous He left the hospital in succession November 10 with a serum CEA plain of 3.7 ng/ml. He continues to do well, without the having recourse more than 2 years after the final operation.

DISCUSSION

This case raises three questions. First, did the three cancers have an independent origin? other did the effects of chemotherapy differ onward the adenocarcinoma and the squamous small room carcinoma? Finally, how should single manage multiple malignant tumors?

Adenosquamous carcinoma was fix in the patient's right lower lobe, while an adenocarcinoma and a squamous solitary abode; squalid carcinoma were recognized separately in his left lower lobe. We questioned whether these tumors exhibited new primary or metastatic lesions. The criteria for the diagnosis of multiple lung cancer propos from Martini and Melamed;x1 are used in general. Nevertheless, it is many times impossible to state with certainty whether a tumor is indeed primary in the case of similar histologic tokens Should that be with equal reason Ferguson et al[2] and Mathisen et al[3] respect to hilar or mediastinal nodal involvement and systemic metastases to make the identification. Considering the histologic characteristics of this case, the adenocarcinoma lesions were clearly not metastatic because a tubular mark was found in the right lung and a papillary archetype was detected in the left lung The origin of the squamous enclosed space carcinoma lesions is less defined, on the other hand it should be considered as a separate primary cancer owing to the absence of the pair nodal involvement and systemic metastases.

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