Abstract
A 62-year-old man was referred to our hospital for an abnormal chest shadow, which was incidentally detected during the treatment of traumatic subarachnoid hemorrhage. Computed tomography scan revealed a 1.8 cm nodule in the left upper pulmonary lobe (S1+2) and multiple osteolytic lesions. FDG-PET/CT scan showed strong accumulation of FDG (SUVmax 3.0) in the lung nodule and mild accumulation in the bone lesions. We planned to perform bone and lung biopsies under general anesthesia to diagnose whether multiple bone lesions were metastases from lung cancer or not. If they were not bone metastases, he could be a candidate for curative surgery. First, a bone biopsy to the iliac lesions was performed in the prone position. The frozen section diagnosis was myeloma. Consequently, a lung biopsy performed in the right lateral position offered a diagnosis of adenocarcinoma. Finally, we made the diagnosis of stage IA (sT1aN0M0) pulmonary adenocarcinoma with multiple myeloma and performed a curative operation : left upper lobectomy and lymph node dissection. As for multiple myeloma, systemic chemotherapy was performed postoperatively in the Department of Hematology. When we encounter multiple bone lesions in a patient with lung cancer, several modalities and aggressive bone biopsy can lead to the accurate diagnosis and curative surgery. We should avoid diagnosing easily. Here, we report a rare case of lung cancer combined with multiple myeloma, which was treated with a curative lung surgery and systemic chemotherapy.
