Immunohistochemistry combined with NGS to assist the differential diagnosis of multiple primary lung cancer with lymph node metastasis - a case report

Sep 24, 2026

Uploaded by Jasmine

Incidence of synchronous multiple primary lung cancers (MPLCs) has increased, yet selecting targeted therapy is challenging because each lesion may harbor distinct driver genes that are not interchangeable across tumors. After surgery, detecting driving mutations is crucial for staging, but lymph node metastatic specimens often contain low tumor cell counts and limited DNA for next-generation sequencing. This rare case report describes double primary lung adenocarcinomas with 10 groups of lymph node metastases, identifying metastasis origin using immunohistochemistry combined with NGS to guide postoperative adjuvant treatment. The combined approach shows clinical promise but warrants larger studies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Case Presentation

Immunohistochemistry and NGS Methods

Results and Diagnostic Reasoning

Discussion

Conclusion

TYPE Case Report PUBLISHED 18 October 2023 DOI 10.3389/fonc.2023.1260759 OPEN ACCESS EDITED BY Brian D. Adams, Brain Institute of America, United States REVIEWED BY Danijela M. Cvetkovic´, University of Kragujevac, Serbia Valerie Sodi, Agilent Technologies, United States *CORRESPONDENCE Yi Ren [renyisyxk@126.com](renyisyxk@126.com) †These authors have contributed equally to this work and share ﬁrst authorship RECEIVED 18 July 2023 ACCEPTED 29 September 2023 PUBLISHED 18 October 2023 CITATION Liu C, Zhang S, Yang H, Bai Y, Shen Y and Ren Y (2023) Immunohistochemistry combined with NGS to assist the differential diagnosis of multiple primary lung cancer with lymph node metastasis: a case report. Front. Oncol. 13:1260759 . doi: 10.3389/fonc.2023.1260759 COPYRIGHT © 2023 Liu, Zhang, Yang, Bai, Shen and Ren. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Immunohistochemistry combined with NGS to assist the differential diagnosis of multiple primary lung cancer with lymph node metastasis: a case report Chang Liu 1†, Shuai Zhang 2†, Hong Yang 3, Yu Bai 4, Yanru Shen 5 and Yi Ren 1* 1 Department of Thoracic Surgery, Shenyang Tenth People’s Hospital, Shenyang Chest Hospital, Shenyang, China, 2 Department of Pediatric Urology, Dalian Women and Children ’s Medical Center (Group), Dalian, Liaoning, China, 3 Department of Pathology, Shenyang Tenth People’s Hospital, Shenyang Chest Hospital, Shenyang, China, 4 Department of Thoracic Surgery, The Second Afﬁliated Hospital of Dalian Medical University, Dalian, China, 5 Medical Project, Berry Oncology Corporation, Fuzhou, Fujian, China In recent years, the incidence of synchronous multiple primary lung cancers (MPLCs) has gradually increased. Surgery is the preferred treatment for these patients. There are great differences in the driving genes between individual tumors in patients with MPLC, and tumors with targeted mutations do not represent other tumors, which challenges the selection of targeted therapies for patients with MPLC. Driving mutations in each lesion after surgery are crucial for establishing accurate pathological staging and subsequent treatment strategies. There are some mutated genes in the lymph nodes of postoperative metastatic MPLCs, and the tumor cell count/DNA concentration is low, which limits the next-generation sequencing (NGS) detection effect. A combination with immunohistochemistry to determine the source of metastasis may be a better choice. This study reports a rare case of lung cancer with double primary adenocarcinomas of the lung combined with 10 groups of lymph node metastases. The source of metastasis was identiﬁed using immunohistochemistry combined with NGS to guide postoperative adjuvant treatment. We hope that this case report can provide new ideas for the identiﬁcation of MPLCs and assist in their diagnosis and individualized treatment. In addition, the combination speciﬁc immunohistochemistry and NGS seems to be an effective identiﬁcation method. This approach can provide clinical beneﬁts; however, this still requires further exploration through studies with large sample sizes. KEYWORDS multiple primary lung cancers, next-generation sequencing, immunohistochemistry, osimertinib, lymph node metastasis Frontiers in Oncology 01 [frontiersin.org](frontiersin.org) 1 Introduction Multiple primary lung cancers (MPLCs) are deﬁned as two or more primary lung cancers that occur in the same patient. Depending on the time of occurrence, they can be divided into synchronous and metachronous MPLCs (1) . With th

FAQs

Why is targeted therapy selection difficult in synchronous multiple primary lung cancers (MPLCs)?

Driver genes can differ between individual tumors in the same patient, so targeted mutations from one lesion may not represent another tumor. This complicates choosing appropriate targeted therapy for MPLCs.

What limitation of NGS affects lymph node metastasis diagnosis in this context?

Postoperative metastatic lymph nodes can have low tumor cell counts and low DNA concentration, which reduces the effectiveness of next-generation sequencing detection.

How did the study identify the metastasis origin for postoperative guidance?

The study used immunohistochemistry combined with NGS to determine the source of lymph node metastases, supporting individualized postoperative adjuvant treatment decisions.

Sep 24, 2026

Uploaded by Jasmine