Comprehensive diagnosis and individualized treatment of multiple primary lung cancer - A case report

Sep 23, 2026

Uploaded by Noah

Low-dose CT has increased the detection of multiple primary lung cancer (MPLC), yet no unified diagnostic standard distinguishes MPLC from intrapulmonary metastasis (IM). A 45-year-old woman with over 20 bilateral lung lesions was admitted after enhanced chest CT suggested IM. Whole-body PET-CT showed an FDG-avid left upper lobe lesion with no abnormal uptake in other lesions, leading to an MPLC diagnosis. After multidisciplinary review, a two-stage bilateral surgery plus adjuvant chemotherapy achieved stable disease.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Epidemiology and clinical challenge

Diagnostic criteria and the role of pathology and molecular features

Case report and treatment course

Imaging assessment and differentiation of MPLC vs IM

Multidisciplinary decision-making and two-stage surgery

Outcomes and follow-up

EXPERIMENTAL AND THERAPEUTIC MEDICINE 31: 92, 2026 Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report GUOXIONG ZENG 1 , YUNYAN ZHOU2 , WANG WAN3 , BIAO DENG3 , CHUNYUAN CHEN3 and ZHU LIANG3 1Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510000, P.R. China; 2Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510000, P.R. China; 3Department of Thoracic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524000, P.R. China Received May 6, 2025; Accepted December 22, 2025 DOI: 10. 3892/etm.2026.13087 Abstract. With the popularity of low‑dose CT, the detection rate of multiple primary lung cancer (MPLC) has gradually increased. However, to the best of our knowledge, no unified standard for diagnosing MPLC currently exists. Therefore, the differentiation of this tumor type from lung cancer intra‑ pulmonary metastasis (IM) can aid the diagnosis of MPLC. The treatment strategies and prognosis of these two tumor types are different. The present report documents the case of a 45‑year‑old female patient with MPLC with >20 lesions in both lungs . Enhanced chest CT imaging indicated IM, prompting admission to the hospital for clarification of the pathology of the lung lesions and for receiving drug therapy. However, whole‑body PET‑CT revealed an anterior left upper lobe lesion with increased F18‑fluorodeoxyglucose (FDG) metabolism (maximum standardized uptake value=7.3) . No abnormal increases in FDG metabolism were found in the other multiple lesions. The data led to a diagnosis of MPLC. Following multidisciplinary discussions, an individualized treatment plan for this patient was developed. The patient was treated with a two‑stage surgery (first surgery on the left lung, second surgery on the right lung) according to the protocol, Correspondence to: Dr Zhu Liang, Department of Thoracic Surgery, Affiliated Hospital of Guangdong Medical University, 57 South Renmin Road, Zhanjiang, Guangdong 524000, P.R. China E‑mail: [liangzhuwsh@163.com](liangzhuwsh@163.com) Abbreviations: MPLC, multiple primary lung cancer; FDG, fluorodeoxyglucose; IM, intrapulmonary metastases; NGS, next‑generation sequencing; LUL, left upper lobe; RUL, right upper lobe; RLL, right lower lobe; TMB, tumor mutation burden; AIS, adenocarcinoma in situ; MIA, minimally invasive adenocarcinoma; IA, invasive adenocarcinoma; PD‑L1, programmed death‑ligand 1; TTF‑1, thyroid transcription factor 1; FEV1, forced expiratory volume in 1 sec; FVC, forced vital capacity; GGN, ground glass nodules Key words: MPLC, diagnosis, molecular detection, next‑generation sequencing, treatment coupled with adjuvant chemotherapy (700 mg pemetrexed combined with 45 mg lobaplatin) between surgeries . For 56 months after the first surgical treatment, the patient did not experience disease progression. The patient's disease‑free survival period is ongoing. In this case, the multiple lesions did not show significant similarities in their histopathological and genomic characteristics. The integration of radiological, histopathological and genomic features by a multidisciplinary team facilitated a more accurate diagnosis of MPLC. This has the potential to become an option for the differential diagnosis of MPLC in the future. In addition, an individualized treat‑ ment design would be more beneficial to patients with MPLC, especially those with a large number of lesions in both lungs. The present study reports a case of the diagnosis and individu‑ alized treatment of MPLC with multiple lesions in both lungs, which provides a reference for the diagnosis and treatment of similar patients. Introduction According to global cancer epidemiological data (GLOBOCAN 2020 statistics), the incidence and mortality of lung cancer rank first among all malignant

FAQs

What was the reported outcome after the first surgical treatment?

For 56 months after the first surgery, the patient had no disease progression, and the disease-free survival period was ongoing, with the lesions showing differing histopathological and genomic characteristics.

Sep 23, 2026

Uploaded by Noah