alexa Synchronous Pulmonary Adenocarcinoma and Mediastinal Non Hodgkin Lymph
ISSN: 1948-5956
Journal of Cancer Science & Therapy
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Synchronous Pulmonary Adenocarcinoma and Mediastinal Non Hodgkin Lymphoma

Marasco Rita Daniela, MD1*, Patitucci Giuseppe, MD2, Della Morte Aniello, MD1, Giudice Gabriella, MD1, Vita Giulia, MD2 and Lequaglie Cosimo, MD1
1Department of Thoracic Surgery, I.R.C.C.S. - C.R.O.B., Referral Cancer Center of Basilicata, Via Padre Pio, n° 1, 85028, Rionero in Vulture (PZ), Italy
2Department of Pathology, I.R.C.C.S. - C.R.O.B., Referral Cancer Center of Basilicata, Via Padre Pio, n° 1, 85028, Rionero in Vulture (PZ), Italy
Corresponding Author : Marasco Rita Daniela
Department of Thoracic Surgery
I.R.C.C.S. - C.R.O.B., Referral Cancer Center of Basilicata, Via Padre Pio, n° 1, 85028
Rionero in Vulture (PZ), Italy
Tel: +39.320.6555275
E-mail: [email protected]
Received May 15, 2015; Accepted June 25, 2015; Published June 29, 2015
Citation: Daniela MR, Giuseppe P, Aniello DM, Gabriella G, Giulia V, et al.(2015) Synchronous Pulmonary Adenocarcinoma and Mediastinal Non Hodgkin Lymphoma. J Cancer Sci Ther 7:190-191. doi:10.4172/1948-5956.1000348
Copyright: © 2015 Daniela MR, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

In the present report we’re going to describe a rare case of synchronous lung adenocarcinoma and non- Hodgkin B-cell lymphoma in both hilar and mediastinal lymphnodes. The primitive pulmonary epithelial neoplasm was effectively managed with a right upper lobectomy and an adjuvant chemotherapy, while the indolent lymphoproliferative disorder did not require any treatment. The 24-month follow up did not show relapses.

Keywords
Synchronous multiple primary neoplasms; Solid neoplasmas; Hematologic neoplasms
Introduction
The simultaneous occurence of lung cancer without mediastinal lymphoadenopaties and malignant lymphoma involving intrathoracic lymph nodes, to the best of our knowledge has never been previously reported in literature.
The incidence of synchronous multiple primary cancer (SMPC) is very low, and it’s even less common to observe concomitant solid tumors with hematological malignancies [1].
In the present paper we aim to describe an unusual case of simultaneoulsy diagnosed pulmonary adenocarcinoma and non Hodgkin lymphocitic lymphoma involving hilar and mediastinal lymph nodes.
Case Presentation
A 59-year-old man, in good general health, former smoker with no significant medical history, was admitted to our department with dry tickly cough, progressive exertional dyspnea and right chest pain arising in the past two months; physical examination was not remarkable. A chest radiograph (Figure 1A) disclosed a gross opacity in the right hilar angle, confirmed by a computed tomography scan, that showed a spiculated para-mediastinal mass in the right upper lobe (7×5 cm), with pericentimetric hilar and mediastinal lymph nodes enlargement (Figures 1B and 1C).
An integrated 18F-FDG-Positron Emission Tomography - Computed Tomography (PET/TC) scan revealed an increased radiopharmaceutical uptake within the pulmonary mass (SUV range: 5.2 - 13.4) and in a homolateral hilar lymphnodes (SUV: 3.4) (Figure 1C).
A flexible fiberoptic bronchoscopy showed a nearly complete endobronchial obstruction of the anterior branch (B3) of the right upper bronchus by a smooth vegetation blocking the ostium; endobronchial biopsies allowed a diagnosis of pulmonary adenocarcinoma.
A right upper lobectomy with radical lymphadenectomy was undertaken through an anterolateral muscle-sparing thoracotomy; the post-operatory course was uneventful and the patient was discharged on the 5th postoperative day.
Immunohistochemical stainings revealed a poorly differentiated, acinar predominant lung adenocarcinoma, with a TTF-1+/ CK7+ immunophenotype, with a contiguous spread to a peribronchial lymph node (Figures 2A and 2B).
According to the TNM 7th edition, the pathological stage was pT2, N1, R0, M0, G3 , The molecular analysis didn’t detect Epidermal Growth Factor Receptor (EGFR) nor Anaplastic Lymphoma Kinase (ALK) genes mutations.
Surprisingly, while assessing hilar and mediastinal lymph nodes, it was found a non Hodgkin B lymphocitic lymphoma (LLC/SLL), with a growth pattern of small sized elements interspersed with large and intermediate cells (prolymphocites and immunoblasts), with a CD20+, CD5+, CD23+ immunophenotipe (Figures 2C and 2D).
The patient received four cycles of adjuvant chemotherapy for the lung cancer (Cisplatin - Gemcitabine), while the indolent lymphoproliferative disorder did not require any treatment. The 24-month follow up did not show recurrences.
Discussion
Collision tumors represent a very rare entity, most of the times diagnosed at the onset of presentation. The diagnostic criteria for Multiple Primary Cancer (MPC), as defined by Warren and Gates [2], include the following conditions: 1) each neoplasm must show specific malignant findings; 2) each lesion must be separate and distinct in site; 3) the possibility that one neoplasm represent a metastatic focus from the other should be excluded.
Synchronous Multiple Primary Cancer (SMPC) is defined as two or more tumors occurring within six months of each other, while heterochronic multiple primary cancer is a subset of SMPC where the second cancer occurs more than six months afer the first one.
The incidence of synchronous epithelial tumors with hematological malignancies is very uncommon, and its etiology and pathophysiology remains still unclear [3,4].
Low grade lymphoproliferative diseases like chronic Lymphocitic Leukemia/Small Lymphocitic Lymphoma (CLL/SLL) have been demonstrated to be frequent components of multiple primary malignant tumors, just as squamous cell carcinoma and adenocarcinoma have been reported as the most common non hematopoietic components [5]. Otherwise, in SLL/CLL patients has been observed an overall increase in the incidence of second cancers: a large retrospective study by Schollkopf et al., showed a statistically significant increase in the relative risk for lung cancer [6]. Sometimes such a combination of tumors presents several challenges in terms of management options and the therapeutic approach to each neoplasm requires separate considerations of their biologic behavior [7].
In the present case, after an accurate staging of both the neoplasms, it was suggested a strict hematologic follow up, but no immediate cure of the lymphocitic lymphoma was undertaken, yet the patient was submitted to an adjuvant systemic treatment for the resected lung cancer, with successful therapeutic outcomes.
Conclusions
The precise mechanism of synchronous multiple primary cancer remains unknown and there are no uniform treatment guidelines, so that the management may be challenging; nevertheless, the prognosis of SMPC patients may be good if the tumors are all at early stage, as in the present case.
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