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Case Report Open Access

Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report

  • Authors:
    • Guoxiong Zeng
    • Yunyan Zhou
    • Wang Wan
    • Biao Deng
    • Chunyuan Chen
    • Zhu Liang
  • View Affiliations / Copyright

    Affiliations: Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510000, P.R. China, Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510000, P.R. China, Department of Thoracic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong 524000, P.R. China
    Copyright: © Zeng et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 92
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    Published online on: February 3, 2026
       https://doi.org/10.3892/etm.2026.13087
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Abstract

With the popularity of low‑dose CT, the detection rate of multiple primary lung cancer (MPLC) has gradually increased. However, to the best of our knowledge, no unified standard for diagnosing MPLC currently exists. Therefore, the differentiation of this tumor type from lung cancer intrapulmonary metastasis (IM) can aid the diagnosis of MPLC. The treatment strategies and prognosis of these two tumor types are different. The present report documents the case of a 45‑year‑old female patient with MPLC with >20 lesions in both lungs. Enhanced chest CT imaging indicated IM, prompting admission to the hospital for clarification of the pathology of the lung lesions and for receiving drug therapy. However, whole‑body PET‑CT revealed an anterior left upper lobe lesion with increased F18‑fluorodeoxyglucose (FDG) metabolism (maximum standardized uptake value=7.3). No abnormal increases in FDG metabolism were found in the other multiple lesions. The data led to a diagnosis of MPLC. Following multidisciplinary discussions, an individualized treatment plan for this patient was developed. The patient was treated with a two‑stage surgery (first surgery on the left lung, second surgery on the right lung) according to the protocol, coupled with adjuvant chemotherapy (700 mg pemetrexed combined with 45 mg lobaplatin) between surgeries. For 56 months after the first surgical treatment, the patient did not experience disease progression. The patient's disease‑free survival period is ongoing. In this case, the multiple lesions did not show significant similarities in their histopathological and genomic characteristics. The integration of radiological, histopathological and genomic features by a multidisciplinary team facilitated a more accurate diagnosis of MPLC. This has the potential to become an option for the differential diagnosis of MPLC in the future. In addition, an individualized treatment design would be more beneficial to patients with MPLC, especially those with a large number of lesions in both lungs. The present study reports a case of the diagnosis and individualized treatment of MPLC with multiple lesions in both lungs, which provides a reference for the diagnosis and treatment of similar patients.

View Figures

Figure 1

Timeline of the present case report.
MPLC, multiple primary lung cancer; NGS, next-generation
sequencing.

Figure 2

Patient CT images. (A) The main
lesion in the lungs (left upper lobe lesion 1); a solid mass shadow
in the irregular part of the anterior segment of the left upper
lobe with blurred edges, visible lobulation, spiculation and
cavitation signs, local pleural traction signs, irregular bronchial
stenosis and occlusion in the lesion. (B-D) The main remaining
lesions (GGNs) of the left upper lung. (E and F) Main lesions
(GGNs) of the right middle lung. (G) Main lesions (GGNs) of the
right upper lung. (H) Main lesions (GGNs) of the right lower lung.
GGNs, ground-glass nodules.

Figure 3

PET-CT images of the patient. (A and
B) Hypermetabolism was observed in the left upper lung lesion
(maximum standardized uptake value=7.3). (C-H) No abnormal increase
in F18-fluorodeoxyglucose metabolism was found in the
other multiple lesions.

Figure 4

Pathology of the lung lesions. (A and
B) Histological examination of the left upper lobe lesion 1 showed
100% papillary subtype adenocarcinoma (H&E). Magnifications,
(A) x200 and (B) x400. (C and D) Histological examination of the
right lower lung lesion 1 showed predominantly adherent type
adenocarcinoma (H&E). Magnifications, (C) x200 and (D)
x400.

Figure 5

Pathological staining results for
samples from both lobes. H&E staining for (A) LUL2, (B) LUL3,
(C) LUL4, (D) LUL5 and (E) LUL6. Staining results indicated
minimally invasive adenocarcinoma. (F) H&E staining of LUL7
showed adenocarcinoma in situ. (G) LUL1 immunohistochemical
staining showed (G) TTF-1 (+), (H) Napsin A (+), (I) cytokeratin 7
(+), (J) Ki67 (10%) and (K) PD-L1 (tumor cells-, interstitial
macrophages+, 50%). Right lower lung lesion 1 immunohistochemical
staining showed (L) TTF-1 (+), (M) Napsin A (+), (N) Ki67 (3%), (O)
carcinoembryonic antigen (-) and (P) PD-L1 (tumor cells-, tissue
cells+, >50%). LUL, left upper lung; TTF-1, thyroid
transcription factor 1; PD-L1, programmed death-ligand 1.

Figure 6

CT images after the two surgeries.
(A-D) CT images after the first surgery in July 2021. High-risk
residual lung nodules remained in the right lower and middle lungs.
(E-H) CT images after the second surgery in May 2025. The residual
lung nodules were stable small GGN stable and have not
progressed.
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Copy and paste a formatted citation
Spandidos Publications style
Zeng G, Zhou Y, Wan W, Deng B, Chen C and Liang Z: <p>Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report</p>. Exp Ther Med 31: 92, 2026.
APA
Zeng, G., Zhou, Y., Wan, W., Deng, B., Chen, C., & Liang, Z. (2026). <p>Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report</p>. Experimental and Therapeutic Medicine, 31, 92. https://doi.org/10.3892/etm.2026.13087
MLA
Zeng, G., Zhou, Y., Wan, W., Deng, B., Chen, C., Liang, Z."<p>Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report</p>". Experimental and Therapeutic Medicine 31.4 (2026): 92.
Chicago
Zeng, G., Zhou, Y., Wan, W., Deng, B., Chen, C., Liang, Z."<p>Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report</p>". Experimental and Therapeutic Medicine 31, no. 4 (2026): 92. https://doi.org/10.3892/etm.2026.13087
Copy and paste a formatted citation
x
Spandidos Publications style
Zeng G, Zhou Y, Wan W, Deng B, Chen C and Liang Z: <p>Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report</p>. Exp Ther Med 31: 92, 2026.
APA
Zeng, G., Zhou, Y., Wan, W., Deng, B., Chen, C., & Liang, Z. (2026). <p>Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report</p>. Experimental and Therapeutic Medicine, 31, 92. https://doi.org/10.3892/etm.2026.13087
MLA
Zeng, G., Zhou, Y., Wan, W., Deng, B., Chen, C., Liang, Z."<p>Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report</p>". Experimental and Therapeutic Medicine 31.4 (2026): 92.
Chicago
Zeng, G., Zhou, Y., Wan, W., Deng, B., Chen, C., Liang, Z."<p>Comprehensive diagnosis and individualized treatment of multiple primary lung cancer: A case report</p>". Experimental and Therapeutic Medicine 31, no. 4 (2026): 92. https://doi.org/10.3892/etm.2026.13087
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