Recommended Citation
Gordon N, Gratza D, Raad W, Alraiyes AH. Recognizing Synchronous Primary Lung Cancer. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Lung cancer remains the leading cause of cancer death worldwide. Therefore, management decisions that follow nodule identification represent a crucial moment in patient care. Synchronous multiple primary lung cancer (SMPLC) refers to the simultaneous diagnosis of two or more distinct cancerous lesions rather than metastasis from a single primary site. This phenomenon is estimated to occur in approximately 2% of patients diagnosed with lung cancer. Although the underlying pathogenesis is incompletely understood, carcinogen exposure is able to create a large area of genetic alteration increasing the risk of dysplasia - a concept known as field cancerization.
Description:
A 71-year-old female presented to the emergency department (ED) for worsening dyspnea and chest pain in the setting of a 10-week nonproductive cough. Social history was significant for a 15-pack-year smoking history, and a family history of lung cancer. Three incidental pulmonary nodules were identified on computed tomography (CT): a 12.5 mm nodule in the left upper lobe (LUL), 10 mm nodule in the LUL, and a 17 mm nodule in the right lower lobe (RLL). Further workup in the ED was otherwise unremarkable. A positron emission tomography (PET)-CT scan revealed that all three nodules had mild avidity with standardized uptake values (SUVs) ranging between 1.75 and 2.24. Findings were discussed with the multidisciplinary tumor board, and biopsy was recommended after lack of interval improvement on a 6-week interval scan. Biopsies acquired via robot-assisted bronchoscopy identified three unique cancers: well-differentiated carcinoid tumor, well-differentiated adenocarcinoma with an acinar pattern, and poorly differentiated adenocarcinoma with a solid pattern. Surgical resection was performed and tolerated without complication.
Discussion:
Recognizing SMPLC is critical to ensuring an accurate diagnosis. Misclassifying unique primary lesions as metastatic disease can lead to missed opportunities for curative treatment. Clinicians should remain vigilant when evaluating patients with multiple pulmonary nodules, particularly those with risk factors. A multidisciplinary approach that incorporates advanced diagnostic technologies, such as robot-assisted bronchoscopy, enables a comprehensive and simultaneous biopsy of multiple nodules during a single procedure. Therefore, early involvement of lung nodule navigators and clinics may enhance patient outcomes in complex lung cancer presentations.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Poster
Open Access
Available to all.
Recognizing Synchronous Primary Lung Cancer
Introduction/Background:
Lung cancer remains the leading cause of cancer death worldwide. Therefore, management decisions that follow nodule identification represent a crucial moment in patient care. Synchronous multiple primary lung cancer (SMPLC) refers to the simultaneous diagnosis of two or more distinct cancerous lesions rather than metastasis from a single primary site. This phenomenon is estimated to occur in approximately 2% of patients diagnosed with lung cancer. Although the underlying pathogenesis is incompletely understood, carcinogen exposure is able to create a large area of genetic alteration increasing the risk of dysplasia - a concept known as field cancerization.
Description:
A 71-year-old female presented to the emergency department (ED) for worsening dyspnea and chest pain in the setting of a 10-week nonproductive cough. Social history was significant for a 15-pack-year smoking history, and a family history of lung cancer. Three incidental pulmonary nodules were identified on computed tomography (CT): a 12.5 mm nodule in the left upper lobe (LUL), 10 mm nodule in the LUL, and a 17 mm nodule in the right lower lobe (RLL). Further workup in the ED was otherwise unremarkable. A positron emission tomography (PET)-CT scan revealed that all three nodules had mild avidity with standardized uptake values (SUVs) ranging between 1.75 and 2.24. Findings were discussed with the multidisciplinary tumor board, and biopsy was recommended after lack of interval improvement on a 6-week interval scan. Biopsies acquired via robot-assisted bronchoscopy identified three unique cancers: well-differentiated carcinoid tumor, well-differentiated adenocarcinoma with an acinar pattern, and poorly differentiated adenocarcinoma with a solid pattern. Surgical resection was performed and tolerated without complication.
Discussion:
Recognizing SMPLC is critical to ensuring an accurate diagnosis. Misclassifying unique primary lesions as metastatic disease can lead to missed opportunities for curative treatment. Clinicians should remain vigilant when evaluating patients with multiple pulmonary nodules, particularly those with risk factors. A multidisciplinary approach that incorporates advanced diagnostic technologies, such as robot-assisted bronchoscopy, enables a comprehensive and simultaneous biopsy of multiple nodules during a single procedure. Therefore, early involvement of lung nodule navigators and clinics may enhance patient outcomes in complex lung cancer presentations.
Affiliations
Advocate Lutheran General Hospital