A Case Report on Carcinoma Lung with Changing Histology Over the Period of Time.
Dr. Anukul Dutta *¹, Dr Pranitha SL², Dr. Geeta SN ³

1,2,3. Dept. of Radiation Oncology, Vydehi Institute of Medical Sciences, Bangalore, India.

Corresponding Author: Dr. Anukul Dutta, Dept. of Radiation Oncology, Vydehi Institute of Medical Sciences, Bangalore, India.

Copy Right: © 2023 Dr. Anukul Dutta, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: May 26, 2023

Published Date: June 10, 2023

Abstract

Lung cancer is the leading cause of cancer death in the World. Histopathology continues to play an essential role in prognosis and choosing appropriate treatment. Largely determined by morphology, primary lung cancers are histologically classified into small cell lung cancers (SCLC) and non-small cell lung cancers (NSCLC), with the latter including adenocarcinoma, squamous cell carcinoma, and large-cell neuroendocrine carcinoma as the main histologic subtypes.

We present a case of 65-year-old male patient who is a known case of treated Squamous cell carcinoma of the left lung with concurrent CTRT 60Gy in 30# with 4 cycles of Etoposide and Cisplatin in 2013. Patient was on regular follow-up until 2017. Then he developed Tuberculosis and took ATT for 6 months. Patient was apparently alright 11months back then he noticed blood streaked sputum associated with cough which is insidious in onset, gradually progressive in nature, for which he was evaluated and got diagnosed with Carcinoma of Right lung Stage IIIA (Adenocarcinoma) S/P 6 cycles of Paclitaxel and Carboplatin, last on 23.01.23

Introduction

The risk for development of a second primary lung cancer (SPLC) after treatment of an initial primary lung cancer (IPLC) is around 1% to 2% per patient. SPLC is defined as a new primary lung cancer that develops after curative intent therapy for the IPLC. The incidence of SPLC has been estimated at approximately 1% to 2% per patient per year.2 The development of a SPLC has been associated with an overall worse survival even after treatment.

The predominant histologic types of the IPLCs were adenocarcinoma and squamous cell carcinoma (58% of all IPLCs). This proportion was higher for the SPLCs with adenocarcinoma and squamous cell carcinomas, which comprised 78% of all cases. IPLC adenocarcinomas most frequently had SPLC

Adenocarcinomas (62%). IPLC squamous cell carcinomas and SCLCs most often presented with SPLC squamous cell carcinomas (45 and 41%, respectively). Only 8% of SPLCs were SCLCs (Tables 3 and 4), which was higher in incidence than the 5% of IPLCs that were SCLCs. Most patients in whom a second primary developed (55%) initially had a localized IPLC, but a small fraction of patients (7%) had distant stage IPLCs (Table 1). Most SPLCs (56%) presented at advanced stages (regional or distant) or were of an unknown stage, whereas only 44% of SPLCs had localized disease.

A Case Report

A 65-year-old male patient, presented with complaints Cough with blood tinged sputum since 5 months, which was insidious in onset, gradually progressive in nature.

He was a chronic smoker until his first cancer diagnosis and treatment and after that had quit smoking, also      presently no history of smoking , had been reported in our hospital On chest auscultation there was decreased air entry in the left side, and right air entry was normal. Rest of the clinical examination was normal. Patient underwent F18 FDG PET CT which showed a large area of consolidation involving the right lung upper lobe anterior segment and adjacent middle lobe with low grade heterogeneous metabolic activity, with mildly enlarged mediastinal lymph nodes, and recommended for clinical correlation and CT guided biopsy. For further evaluation, a biopsy from Right lung depicted the picture of Adenocarcinoma possibly of invasive mucinous adenocarcinoma. Thus being a rare condition of occurrence of different.

Treatment Details

Thus the treatment was planned with Targeted therapy giving Pembrolizumab and Carboplatin based on EGFR, ALK positivity. Further due to raising pattern of Creatinine, the plan was changed to Paclitaxel and Carboplatin. Currently patient on Radiation therapy as part sequential CTRT regimen for dose of 66Gy in 33#.

Results

Patient was given systemic therapy as Chemotherapy and immunotherapy options , also was managed symptomatically for the cough and hemoptysis episodes and other complaints.

Receiving Pembrolizumab and Carboplatin had led to increase in Creatinine thus planned to Paclitaxel and Carboplatin.

Further after patient responded well, also symptoms were improved, cough subsided and he was doing well, thus with haemodynamically stable patient was discharged with every 3weeks follow up for continuing chemotherapy and also to discuss if any new complaints were present. Regular blood reports were done to check on liver and kidney functions and also hemoglobin levels. Currently patent on radiation therapy treatment as part of sequential regimen.

Discussion

In recent years, with the continuous advancement of medical technology and the improvement of patient compliance, many cancer patients have been diagnosed with new primary malignant tumors in their lungs. In the past, a large number of studies have focused on single primary lung cancer or multiple primary lung cancer (MPLC), but there are few studies on lung cancer patients with other primary malignancies. To date, little is known about the regularity of the time interval between two primary malignancies and the prognosis of dual primary cancer patients with LCSPM.

Abbreviations

MPC, multiple primary cancers;

MPLC, multiple primary lung cancers;

LCSPM, lung cancer as a second primary malignancy; FPC.

References

1. Congkuan song, Donghu yu, Yujin wang et al. Dual Primary Cancer Patients With Lung Cancer as a Second Primary Malignancy: A Population-Based doi.org/10.3389/fonc.2020.515606

2. Li F, Zhong WZ, Niu FY, Zhao N, Yang JJ, Yan HH, et al. Multiple primary malignancies involving lung cancer. BMC Cancer (2015) 15:696. doi: 10.1186/s12885-015-1733-8

3. Kim SW, Kong KA, Kim DY, Ryu YJ, Lee JH, Chang JH. Multiple primary cancers involving lung cancer at a single tertiary hospital: Clinical features and prognosis. Thorac Cancer (2015) 6:159–65. doi: 10.1111/1759-7714.12158

4. Thakur MK, Ruterbusch JJ, Schwartz AG, Gadgeel SM, Beebe-Dimmer JL, Wozniak AJ. Risk of Second Lung Cancer in Patients with Previously Treated Lung Cancer: Analysis of Surveillance, Epidemiology, and End Results (SEER) Data. J Thorac Oncol (2018) 13:46–53. doi: 10.1016/j.jtho.2017.09.1964