Synchronous primary lung carcinoma
They are thought to the carry the same pathophysiological mechanism as metachronous lung carcinoma (i.e. two or more primary lung cancers occurring in different portions of the lung spaced in time). Both synchronous and metachronous lung cancers are sometimes cumulatively described under the umbrella term "multiple primary lung cancer (MPLC)" 1.
They are rare with the reported incidence of synchronous multiple primary lung cancer being reported ranging from 0.26 to 1.33% 5,6.
Synchronous lung carcinomas can be represented by various histological types although statistically they are more commonly represented by squamous cell carcinoma of the lung 5.
Treatment and prognosis
Prognosis can widely vary dependent on the stage, grade and subtype of each tumor. In resectable cases, pneumonectomy is the generally considered operation of choice for synchronous unilateral tumors. When bilateral, sequential resection starting with the most advanced lesion has sometimes being proposed 2. As a crude general rule, synchronous cancers are thought to carry a more favorable prognosis compared with metastatic nodules 7.
In imaging consider:
- intrapulmonary metastases from primary lung cancer, i.e. one of the lesions can be a primary while the other metastases
- two or more intrapulmonary from cancer from outside the lung, i.e. both or all lesions are metastases
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- 3. Adebonojo SA, Moritz DM, Danby CA. The results of modern surgical therapy for multiple primary lung cancers. Chest. 1997;112 (3): 693-701. Pubmed citation
- 4. Rea F, Zuin A, Callegaro D et-al. Surgical results for multiple primary lung cancers. Eur J Cardiothorac Surg. 2001;20 (3): 489-95. Pubmed citation
- 5 .Yoon HJ, Lee HY, Han J et-al. Synchronous triple primary lung cancers: a case report. Korean J Radiol. 2014;15 (5): 646-50. doi:10.3348/kjr.2014.15.5.646 - Free text at pubmed - Pubmed citation
- 6. Hiraki A, Ueoka H, Yoshino T et-al. Synchronous primary lung cancer presenting with small cell carcinoma and non-small cell carcinoma: diagnosis and treatment. Oncol. Rep. 1999;6 (1): 75-80. Pubmed citation
- 7. UyBico SJ, Wu CC, Suh RD et-al. Lung cancer staging essentials: the new TNM staging system and potential imaging pitfalls. Radiographics. 2010;30 (5): 1163-81. doi:10.1148/rg.305095166 - Pubmed citation