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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.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/immunohistochemistry-combined-with-ngs-to-assist-the-differential-diagnosis-of-multiple-primary-lung-cancer-with-lymph-node-metastasis-a-case-report/383012/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/immunohistochemistry-combined-with-ngs-to-assist-the-differential-diagnosis-of-multiple-primary-lung-cancer-with-lymph-node-metastasis-a-case-report/383012.png","ImageObject",300,407,{"name":92,"@type":93},"Jasmine","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-24","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is targeted therapy selection difficult in synchronous multiple primary lung cancers (MPLCs)?","Question",{"text":112,"@type":113},"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.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What limitation of NGS affects lymph node metastasis diagnosis in this context?",{"text":117,"@type":113},"Postoperative metastatic lymph nodes can have low tumor cell counts and low DNA concentration, which reduces the effectiveness of next-generation sequencing detection.",{"name":119,"@type":110,"acceptedAnswer":120},"How did the study identify the metastasis origin for postoperative guidance?",{"text":121,"@type":113},"The study used immunohistochemistry combined with NGS to determine the source of lymph node metastases, supporting individualized postoperative adjuvant treatment decisions.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},383012,1790553970,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},2336478487870,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","TYPE Case Report  \nPUBLISHED 18 October 2023 DOI 10.3389/fonc.2023.1260759  \nOPEN ACCESS  \nEDITED BY  \nBrian D. Adams,  \nBrain Institute of America, United States  \nREVIEWED BY  \nDanijela M. Cvetkovic´, University of Kragujevac, Serbia Valerie Sodi,  \nAgilent Technologies, United States  \n*CORRESPONDENCE Yi Ren  \n [renyisyxk@126.com](renyisyxk@126.com)  \n†These authors have contributed equally to this work and share first authorship  \nRECEIVED 18 July 2023  \nACCEPTED 29 September 2023  \nPUBLISHED 18 October 2023  \nCITATION  \nLiu 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  \nlung cancer with lymph node metastasis: a case report.  \nFront. Oncol. 13:1260759 .  \ndoi: 10.3389/fonc.2023.1260759  \nCOPYRIGHT  \n© 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.  \nImmunohistochemistry combined with NGS to assist the differential diagnosis of multiple primary lung cancer with lymph node metastasis: a case report  \nChang Liu 1†, Shuai Zhang 2†, Hong Yang 3, Yu Bai 4, Yanru Shen 5 and Yi Ren 1*  \n1 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  \nIn 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.  \nKEYWORDS  \nmultiple primary lung cancers, next-generation sequencing, immunohistochemistry, osimertinib, lymph node metastasis  \nFrontiers in Oncology 01 [frontiersin.org](frontiersin.org)  \n1 Introduction  \nMultiple 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","cbCaig0Ivkk0l00x","https://ap.wps.com/l/cbCaig0Ivkk0l00x","pdf",1482870,"English","# Introduction\n# Case Presentation\n# Immunohistochemistry and NGS Methods\n# Results and Diagnostic Reasoning\n# Discussion\n# Conclusion","[{\"question\":\"Why is targeted therapy selection difficult in synchronous multiple primary lung cancers (MPLCs)?\",\"answer\":\"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.\"},{\"question\":\"What limitation of NGS affects lymph node metastasis diagnosis in this context?\",\"answer\":\"Postoperative metastatic lymph nodes can have low tumor cell counts and low DNA concentration, which reduces the effectiveness of next-generation sequencing detection.\"},{\"question\":\"How did the study identify the metastasis origin for postoperative guidance?\",\"answer\":\"The study used immunohistochemistry combined with NGS to determine the source of lymph node metastases, supporting individualized postoperative adjuvant treatment decisions.\"}]","Immunohistochemistry combined with NGS to assist the differential diagnosis of multiple primary lung cancer with lymph node metastasis - a case report | PDF",1790253605,13]