A surgical case of quadruple lung cancer

The patient was a 50-year-old male psychiatrist with a history of smoking 3 packs of cigarettes per day for 30 years. Chest computed tomography (CT) showed a nodular shadow in the left S6 segment in April 2002, for which thoracoscopic partial resection of the lung was performed. Because adenocarcinoma was diagnosed by intraoperative frozen sectioning, a left lower lobectomy and lymph node dissection were performed. The pathological diagnosis was adenocarcinoma with mixed subtypes (AMS, pT1N0M0). Cytologically, the tumor cells exhibited tall columnar eosinophilic cytoplasm. In March 2005, chest CT showed a nodular shadow in the right S3 segment, and thoracoscopic partial resection of the lung was performed. Histopathological examination revealed AMS (pT1N0M0). Cytologically, cancer cells showed cuboidal cytoplasm. In November 2007, a nodular shadow appeared in the right S4 segment on chest CT, and thoracoscopic partial resection of the middle lobe and the portion of the upper lobe that had adhered to the middle lobe was performed. Histologically, the middle-lobe tumor was solid adenocarcinoma with mucin (pT1N0M0). Although no gross tumor could be identified in the upper lobe, histological examination revealed nonmucinous bronchioloalveolar carcinoma (pT1N0M0). The patient is currently following a favorable course. Herein, we report a surgical case of quadruple lung cancer.