Background: The appearance of multiple malignancies in the same
patient is a relatively rare occurrence, which can either be synchronous
or metachronous. The etiology is multifactorial and some of the factors
involved in the pathogenesis of these conditions include genetic
predisposition, immunodefiency, radiation therapy, chemotherapy and
various infectious agents. We report the case of a patient with squamous cell
lung cancer in whom non-Hodgkin lymphoma was accidentally found in
paratracheal lymph nodes.
Patients and methods: A 68-year-old man, with a known history of
squamous cell carcinoma of the right lung, presented to our hospital
with persevering hemoptysis. An emergency right pneumonectomy and
regional lymphadenectomy was performed. A tumor, measuring 6 cm,
was found in the middle and lower lobe.
Results: Histological evaluation revealed a malignant neoplasm
composed of nests of large-sized, pleomorphic and atypical cells
in fibrous stroma, intercellular bridges, pearl formation and areas
of necrosis. Histological findings consisted with well differentiated
squamous cell carcinoma of the lung, with lymph node metastasis.
During histological examination in most paratracheal lymph nodes a
diffuse expansion of small-sized lymphoid cells was unexpectedly found.
The immunohistochemical examination led us to the diagnosis of a non-
Hodgkin lymphoma. The patient died 18 days after surgical operation.
Conclusions: The incidence of multiple primary malignancies is expected
to increase due to the better screening methods, which are essential
for carcinoma diagnosis and follow-up. Simultaneously, the progress in
molecular biology contributes to further understanding of carcinogenesis.