Comprehensive diagnosis and individualized treatment of multiple primary lung cancers: a case report

Background: With the popularity of low-dose computed tomography (CT), the detection rate of multiple primary lung cancer (MPLC) has gradually increased. However, there is still no unified standard for diagnosing MPLC, and it needs to be differentiated from intrapulmonary metastasis. The treatment strategies and prognosis of the two are different. Case presentation: A 45-year-old female MPLC patient with more than 20 lesions in both lungs with the enhanced chest CT showed intrapulmonary metastases (IM). She was admitted to the hospital for the purpose of clarifying the pathology of lung lesions and receiving drug therapy. However, Whole-body positron emission tomography (PET) -CT revealed an anterior left upper lobe lesion with increased F 18 fluorodeoxyglucose (FDG) metabolism (SUVmax=7.3). No abnormal increase in FDG metabolism was found in the other multiple lesions. It was biased toward diagnosing MPLC. After a multidisciplinary discussion, we developed an individualized treatment plan for this patient. Patients were treated with a second-stage surgery according to the protocol, as well as adjuvant chemotherapy between surgeries. For a total of 21 months from the first surgical treatment, the patient did not experience any disease progression. Conclusions: : Integrating radiological, histopathological, and genomic features by a multidisciplinary team facilitated a more accurate diagnosis of MPLC. It will be a new trend in the differential diagnosis of MPLC in the future. Moreover, an individualised treatment design is more beneficial to patients for MPLC with a large number of lesions in both lungs. We share a case of the diagnosis and individualized treatment of MPLC with ultra-multiple lesions in both lungs, which provides a reference for the diagnosis and treatment of similar patients.