Synchronous Multiple Primary Lung Cancer Dignosed ？by Different Phenotype-genotype: A Case Report and Literature Review

In recent years, based on low-dose computed tomography (CT) scan developed for physical examination, the number of synchronous multiple primary lung cancer (SMPLC) has gradually increased. The research showed the morbidity of SMPLC up to 0.2%-8%. The current diagnostic criteria of SMPLC is Martini-Melamed criteria. SMPLC: (1) Tumours should be located distantly and separately; (2) Histological types: Different histology; If same histology, they should be located at different segment, lobe or lung and originated from carcinoma insitu. No presence of carcinoma at shared lymphatic drainage. No extrapulmonary metastases at the diagnosis. MMPLC: (1) Different histology; (2) Disease free duration more than 2 years. Originated from carcinoma in situ location of second cancer at different lobe or lung. No presence of carcinoma at shared lymphatic drainage. No extrapulmonary metastases at the diagnosis. In 2013 International association for lung cancer research (IASLC) amended and supplemented the Martini-Melamed criteria, by multidisciplinary classification of lung adenocarcinoma, epidermal growth factor receptor (EGFR), K-ras added for differential diagnosis. It also suggest that the gene mutation detection for each lesion of SMPLC is especially significant for therapeutic strategy. We herein report the case of a 60-year-old woman diagnosed with SMPLC of four adenocarcinoma and EGFR-mutated lesions, who received lung resection for each lesions.