Long-term Disease-Free Survival of a Patient With Synchronous Bilateral Lung Adenocarcinoma Displaying Different EGFR and C-MYC Molecular Characteristics

The second interaction to consider is the potential effect of the airway edema on subsequent bronchoconstriction. Thickening of the airway wall has been hypothesized to be one of the mechanisms contributing to airway hyperresponsiveness in asthma. Acute changes in thickness can occur from inflammation or from local edema caused by vascular leakage in the wall. Such acute airway wall thickening secondary to edema formation has been proposed as a possible cause of wheezing in patients with congestive heart disease in left ventricular failure. As the heart failure improves, pulmonary function also improves. Although it cannot be ruled out that airway edema led to bronchocon-striction, given the clinical scenario it remains more likely that in this case the bronchoconstriction indeed came first, perhaps even generating a “downward spiral” of edema, airway narrowing, and bronchoconstriction.

The main difficulty with multiple lung tumors is distinguishing synchronous and metachronous lesions from second independent primary tumors, particularly when dealing with the same histologic type. Challenging diagnostic hurdles may explain, at least in part, the extremely variable (0%-79%) 5-year survival rate. We present a case report of a patient with synchronous primary adenocarcinoma treated with surgery that exhibited different EGFR gene status, with an exon 19 mutation in the adenocarcinoma of the left upper lobe that was absent in the right upper lobe. Further, specific EGFR and C-MYC amplification events were associated only with the EGFR-mutated lesion. According to an independent evolution theory, these events were classified as early stage, and the patient is still alive and free of disease 70 months after surgery. Molecular evaluation was an important tool to support the diagnosis of synchronous primary adenocarcinoma, which had not been possible with the application of Martini-Melamed criteria.

Background: Impairment and risk are considered separate domains of asthma control, but relationships between them are not completely understood. We compared three validated questionnaires reflecting asthma impairment in their ability to predict future exacerbations.

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