We describe a case of synchronous primary lung cancer presenting with small lonely dwelling carcinoma and adenocarcinoma.

We describe a case of synchronous primary lung cancer presenting with small lonely dwelling carcinoma and adenocarcinoma, in which expression of the small cavity surface antigens and also tumor markers were evaluated immunohistologically. A review of the literature concerning synchronous or metachronous primary lung cancers is also presented

GST-[pi] = glutathione s transferase [pi]; MoAb = monoclonal antibody; NSE = neuron-specific enolase; SCLC = small solitary abode; squalid lung carcinoma

Multiple primary lung cancers arising synchronously or metachronously are not self-same rare. Most reported cases of metachronous or synchronous tumors were shown to have the same histologic impressed signs of lung cancer. Among possible combinations, squamous enclosed space carcinoma was by far the in the greatest degree common;[1-3] however, to date, there have been highly few cases documented with the two small cell lung carcinoma (SCLC) and adenocarcinoma. We existing a case of synchronous lung cancers with a surpassingly rare combination, showing for the first time an evaluation of one as well as the other the expression of cell surface antigens and tumor markers.

Case Report

This 63-year-old man who consum 30 cigarettes by day for 40 years was admitted to Aichi Cancer Center Hospital in October 1988 because of difficulties in breathing. The chest x-ray film revealed tumor shadows in the right upper and lower lobes, and bronchoscopic examination showed the right ventral segmental bronchus of the upper lobe almost completely retarded by a smooth-surface tumor and the right basal bronchus completely interrupted with an irregular tumor screened by a mucous membrane (Fig 1) Histologic evaluation revealed a diagnosis of moderately differentiated adenocarcinoma in the upper lobe and intermediate-type SCLC in the lower lobe (Fig 2) Examination according to computed tomography of the chest, abdomen, and brain, as well as according to bone scintigraphy and bone marrow biopsy, revealed no extrapulmonary metastases or primary tumors, moreover pleural effusion containing small small room carcinoma was found in the right pleural cavity. Based upon a new international staging order for lung cancer,[4] these different tumors were classified as T2/T4N2 and were diagnosed as synchronous lung cancer. The patient was ineligible for surgical intervention owed to pleural effusion and in such a manner underwent combination chemotherapy (regimen for SCLC) with cisplatin (total dose, 240 mg/[msup2]) doxorubicin (adriamycin) (240 mg/[msub2]) cyclophosphamide (3000 mg/[msup2]) and etoposide (1260 mg/[msup2]) With three courses of chemotherapy a out and out response was achieved in the lesion in the lower lobe (SCLC) and a partial rejoinder was seen in the lesion in the upper lobe (adenocarcinoma). Serum horizontals of neuron-specific enolase (NSE) hurl down to within normal ranges (from 46 ng(ml to 3 ng/ml) although carcinoembryonic antigen and glutathione s transferase [pi] (GST-[pi]) remained (40 ng/ml to 18 ng/ml and 70 ng/ml to 40 ng/ml respectively).[5] The patient subsequently underwent radiation therapy (5000 cGy) He was discharged after completing treatment and was doing well, with no signs of any tumor progression; however, he died abruptly of a heart attack 9 month after the initial chemotherapy.

The phenotypes of these tumors were examined by means of two monoclonal antibodies (MoAbs), NE150 and PE35[6] which can differentiate the status of lung cancers. The MoAb, NE150 reacts with the neuroendocrine differentiation antigen (Mr 150000) now known as the neural enclosed space adhesion molecule, while the MoAb, PE35 exposes the antigen (Mr 35,000) quick in emergencies on most epithelial cells, including SCLC confined apartments From data presented at the International Workshop forward SCLC Antigens in London in 1987 and 1990 it was construct that the NE150 and PE35 antigens give an account of cluster 1 and cluster 2 respectively, in SCLC[78] Adenocarcinoma exhibited a typical non-SCLC (NSCLC) phenotype, [NE150sup-]/[PE35sup+] whereas SCLC showed both the NE150 and PE35 antigens as most numerous SCLC tumors.[6,9] Immunohistochemical evaluation also revealed NSE faintly positive in adenocarcinoma and vehemently positive in SCLC, with GST-[pi] represented only in adenocarcinoma (Fig 2)

Discussion

The original criteria for multiple lung cancers were first reported in 1932 by way of Warren and Gates,[10] who stated that each tumor must show a definite picture of carcinoma and must be distinct and that probability of the same lesion metastasizing from another must be exclud There is general agreement from first to last the literature regarding the validity of these criteria, with simply minor modifications.

across the past 27 years, more than 2500 patients have been treated for lung cancer at Aichi Cancer Center and 25 of these were diagnosed as having multiple lung cancers (just subordinate to 1 percent of all lung cancers seen; Table 1) The event of multiple lung cancers has been reported at a number of institutions. Evaluations across several large series have shown that the frequent occurrence of multiple lung cancers varies from 1 to 4 percent (Table 1) In from one side of to the other two thirds of these cases, the metachronous or synchronous tumor had the same histologic protoplast of lung cancer, whereas multiple synchronous primary tumors presenting with different histologic symbols were quite uncommon. Among the cases with differing histologic findings, sole a few cases were reported to have small confined apartment carcinoma and adenocarcinoma.

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