024. Synchronous bilateral lung carcinomas: a case presentation

Background: Synchronous lung carcinomas are characterized by the simultaneous presence of two or more tumors of the same or different histological type, observed in different lobes or different segments of the same lobe. The characterization of these tumors as synchronous primary lung carcinomas is obtained after excluding either the case of intrapulmonary metastases of a primary lung carcinoma or pulmonary metastases originating from primary carcinomas in different organs.

Objective: The presentation of a case with two synchronous bilateral lung carcinomas indicating that diagnostic procedures are required to be separately performed with each lesion, in patients with more than one lesion, to avoid clinical misstating.

Case presentation: Two bilateral synchronous lung carcinomas of different histological types were diagnosed and immunohistochemically confirmed in a 59-year-old male. In biopsy specimens deriving from a mass in the lower lobe of the left lung a moderately differentiated squamous cell carcinoma was detected as confirmed immunohistochemically (p63+, Ck5/6+). In biopsy specimens from a mass in the upper lobe of the right lung a poorly differentiated large cell carcinoma was detected. The immunophenotype (Ck8/18+, Ck7+, Ck19+/-, CD10+, BerEP4-/+, CD56+, Ck5/6-, p63-, synaptophysin-, chromogranin-, EMA-/+, pCEA-, TTF-1-) was consistent with adenocarcinoma, focally with neuroendocrine differentiation. In the histological report of the second biopsy, careful screening of the patient was emphasized, in order to exclude a metastatic carcinoma.

Conclusions: The biopsy of each separate pulmonary lesion should be performed in early stages, because the correct staging is crucial for the evaluation and prognosis of the disease providing guidance for the most appropriate treatment strategy.

Keywords: Lung cancer bilateral; bronchoscopy; carcinoma