Abstract
Introduction: Synchronous multiple primary lung tumors (SMPLT) are a rare and challenging entity, characterized by simultaneous presence of distinct primary lung cancers within the same patient. This condition requires careful diagnostic workup to differentiate separate primaries from metastatic disease, as treatment and prognosis differ. This abstract explores a case of SMPLT, highlighting complexities and clinical considerations in managing dual lung malignancies. Case Presentation: 57-year-old man with a history of COPD on 1.5 L of chronic oxygen, coronary artery disease status-post PCI, aortic aneurysm, hypertension and pulmonary embolism presented with chest pain. He reported a recent move from Yuma, where, three months prior, he was informed of a left lung mass. Now living in Phoenix, he described worsening dyspnea, left-sided chest pain, a productive cough with brown sputum, chills, night sweats, and weight loss. He smokes five cigarettes daily. A CT scan revealed a 7 cm mass in the left upper lobe and a 1.1 cm nodule in the right lower lobe. Interventional pulmonology was consulted and he underwent bronchoscopy with EBUS-guided biopsy showing a preliminary diagnosis of squamous cell carcinoma without involvement of mediastinal and hilar lymph nodes, prompting transfer to the oncology service. Subsequent imaging, including an MRI of the brain, showed no other lesions; however, the right lower lobe nodule raised concerns as either a metastasis or a second primary tumor. Biopsy by interventional radiology confirmed it as a high-grade neuroendocrine tumor consistent with small cell carcinoma. Discussion: This case illustrates diagnostic and management complexities in a patient with synchronous primary lung tumors of distinct histologies. The patient's mentioned clinical presentation and smoking history initially raised suspicion for malignancy, which was confirmed upon biopsy as both squamous cell carcinoma and a separate high-grade neuroendocrine tumor consistent with small cell carcinoma. The presence of synchronous lung tumors with different pathologies presents unique challenges. Differentiating between metastasis and a second primary tumor is critical, as treatment approaches differ. In this case, the neuroendocrine tumor in the right lower lobe requires distinct therapeutic consideration from the left upper lobe squamous cell carcinoma. Additionally, the patient's comorbidities, including COPD, coronary artery disease, and recent weight loss, complicate his tolerance to potentially aggressive therapies. Robotic bronchosocpy is now the most commonly used diagnostic modality for simultaneous biopsy of multiple bilateral pulmonary nodules. Conclusion: This case highlights the importance of multidisciplinary coordination to optimize diagnostic accuracy and tailor treatments in cases of potential SMPLT.