Case Presentation: A 74-year-old individual, a heavy smoker, was diagnosed with advanced Stage III prostate cancer and subsequently underwent androgen deprivation therapy coupled with radiotherapy. Two years later, during active surveillance, the patient experienced exertional dyspnea, prompting a chest CT scan. The scan revealed two significant findings: a complete occlusion of the right upper lobe anterior segmental bronchus with a spiculated solid noncalcified nodule measuring 16 x 11 mm and a similar occlusion in the left upper lobe anterior segmental bronchus, accompanied by extensive retained secretions in the airway. The possibility of an endobronchial lesion was suggested. Further evaluation through PET/CT highlighted hypermetabolic lesions in both upper lobes, with indications of an endobronchial component in the left upper lobe. The patient underwent bronchoscopy and lung biopsy on both sides. The biopsy from the right lung revealed poorly differentiated adenocarcinoma, while the left lung biopsy surprisingly exhibited histological features indicative of squamous cell carcinoma. At this juncture, the patient had three distinct cancers, posing a challenge in determining treatment strategies for the newly diagnosed conditions. Radiation temporarily stabilized the diseases; however, after two years, the patient’s condition deteriorated, presenting with more lung masses, pleural nodules, and bone lesions. Due to the patient’s declining health, biopsy was no longer feasible, and analysis of pleural fluid confirmed metastatic lung cancer. A palliative care approach was then undertaken.
Discussion: This case marks the first reported occurrence of simultaneously presenting disparate histological types of lung cancer in both lungs alongside prostate cancer. Multiple Primary Malignancies (MPM) coexisting within an individual present a rare yet compelling scenario in the medical landscape. Cancer survivors face escalated risks of secondary cancers attributed to various factors, encompassing host susceptibility, shared risk factors, treatments, and surveillance practices. The incidence of MPM has shown an increasing trend, possibly owing to enhanced screening methods and improved cancer treatments. While synchronous multiple primary lung cancers are relatively infrequent, genetic factors such as BRCA mutations are associated with susceptibility to multiple malignancies (1). Treatments like chemotherapy and radiotherapy can also contribute to the development of secondary malignancies (2) . Environmental and lifestyle factors, notably tobacco and alcohol use, significantly heighten the risk of various cancers. Chronic stressors and biological strain may also play a role in cancer risk, although their exact contributions to MPM development remain unclear (3).
Conclusions: This case highlights the intricate nature of MPM, emphasizing the essential requirement for clinicians to grasp the diverse factors impacting their development, prognosis, and treatment. As screening tools improve and treatment options expand, there is an increasing population of individuals surviving their initial cancer diagnosis, necessitating heightened awareness among hospitalists. This necessitates considering the possibility of a new cancer emerging in patients with a history of malignancies, expanding diagnostic considerations.