A Case of Multiple Nodules in a Patient with Lung Cancer – A Diagnostic Challenge

In a patient with diagnosis of lung cancer, the appearance of multiple nodules during follow-up raises various differential diagnosis. The treatment strategy may be different depending on its diagnosis, so the correct approach is crucial. We present a case report of a 69-year-old male that was diagnosed with a lung adenocarcinoma stage IB in 2008 that underwent right upper lobectomy and adjuvant chemotherapy. Ten years later, during follow-up, 6 new nodules appeared on CT scan, 5 of them were biopsied. Four of these nodules were adenocarcinoma and one had histological features of atypia. Only 2 nodules showed similar molecular characteristics, being all the other nodules different from each other. It was assumed they were three synchronous pulmonary neoplasms (the 2 nodules similar to each other were assumed to have the same origin) and patient underwent stereotactic body radiation therapy (SBRT) of all malignant lesions followed by additional chemotherapy. Three years later, there is no signs of relapsing. This clinical case shows the challenge that patients with multiple nodules can be and highlights the importance of a multidisciplinary discussion in the decision of diagnostic and therapeutic approach.