Benefit of a Second Opinion for Lung Cancer: No Metastasis to the Kidney but a Synchronous Primary Renal Neoplasm
A 48-year-old female received palliative radiotherapy (30 Gy) directed to vertebrae Th9-Th12 and 4 cycles of chemotherapy [gemcitabin 1,200 mg/m2 (on days 1 and 8), carboplatin 80 mg/m2] for an 18-FDG-PET avid, thyroid transcription factor-1 (TTF-1) positive adenocarcinoma of the right lower lobe invading the thoracic vertebrae 10, and an additional 18-FDG-PET negative lesion in the right kidney, cytology-confirmed adenocarcinoma, considered as a distant metastasis (cT4NxM1). Therapy resulted in a slight reduction of both lesions. Due to the determined stage (IV), an expectative approach was opted. The patient initiated a second opinion.\nThe patient's data were reviewed and additional 18-FDG-PET and CT scans were performed. Except for the presence of the lesion in the kidney, no signs of metastases were found. Therefore, the initial diagnosis was reconsidered as two primary tumors: an adenocarcinoma of the lung, stage IIIB (cT4N0M0) and an adenocarcinoma of the right kidney (cT1a). Two cycles of neo-adjuvant chemotherapy (cisplatinum 80 mg/m2, pemetrexed 500 mg/m2 on days 1 and 21) were administered prior to lung surgery. Surprisingly, no tumor was found in the right lower lobe perioperatively. A hemicorporectomy of Th10 and a resection of the processus transversus of Th10 and Th11 were performed, followed by spine stabilization.\nWith regard to the lesion of the right kidney, an expectative approach was agreed because of stable disease (no growth), its localization (in the mid pole of the kidney) and small size (2.3 cm). Eleven months later, cryoablation was ultimately performed because the patient insisted on removal of the tumor, which revealed a papillary renal cell carcinoma. The postoperative course was uneventful. The patient is doing well more than 6 years after the initial diagnosis.