Varying programmed death ligand-1 expression levels in a patient with four synchronous lung cancers – a case report

Abstract

The rising understanding of the programmed death ligand 1 (PD-L1) expression and its molecular foundation has served as an innovating force in both diagnostic assessment and therapy of lung cancer. However, we notice a trend regarding vast heterogeneity of PD-L1 expression, mutation, and further genetic characteristics.We report a unique case of a patient with four synchronous adenocarcinomas with variations in the genetic expression. In case of multiple tumor nodules, adjuvant chemotherapy is discussed in most of the cases. In our patient, the identification of synchronous lung cancer made us pursue a “wait and watch” therapy, rather than chemotherapy. Clinical follow up as well as staging show complete remission without any signs of new tumor manifestations. Therefore, we conclude that it is necessary to clearly understand the genetic foundation of synchronous lung cancer as well as it is variations to offer the best possible treatment for this complex patient group.

Keywords

• Synchronous lung cancer
• PD-L1 expression
• Molecular analysis
• Case report