On follow-up chest X-ray film a nodular shadow was detected in the right lower lung field in a 65-year-old man, who had been treated for interstitial pneumonia. Because serum CEA level was elevated (10.6ng/ml) and the abdominal examinations revealed no abnormal findings, primary lung cancer was strongly suspected. Right middle and lower lobectomy was performed. A nodule in the lower lobe was adenocarcinoma and another small nodule was detected in the middle lobe. Pathologically the nodule in the middle lobe was also carcinoma composed of squamous cell carcinoma and small cell carcinoma. Metastases for squamous cell carcinoma was detected in the mediastinal lymph nodes. This case was synchronous multiple primary lung cancer, one primary adenocarcinoma in the lower lobe and another primary carcinoma in the middle lobe consisting of two differrent histological types.
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