Imaging of synchronous multiple primary lung adenocarcinoma with concomitant EGFR and KRAS mutations: a case report and review of the literature

With the application of computed tomography (CT) imaging technology, the incidence rate of multiple primary lung cancer has gradually increased. However, the prevalence of concomitant epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene (KRAS) mutations in patients with non-small cell lung cancer (NSCLC) is low, and cases of concomitant EGFR and KRAS mutations have rarely been reported. In this case, we report a 71-year-old male patient with multiple primary lung adenocarcinoma harboring different gene mutation subtypes of KRAS and EGFR. The lesions in different lung lobes had distinct imaging features. One lesion was a solid mass in the upper lobe of the left lung, and the other was a cyst-like lung adenocarcinoma in the upper lobe of the right lung. Laboratory tests were positive for the marker carcinoembryonic antigen (CEA). The patient underwent thoracoscopic resection of the bilateral lung lesions, received chemotherapy and immunosuppressant therapy and exhibited progression-free survival (PFS) for 1 year. Later, the patient developed mediastinal lymph node and brain metastasis and died of multiple metastases. It is important to note that lung lesions with distinct imaging features may be associated with different types of gene mutations. Prediction of the gene mutation phenotype of lesions based on differences in imaging features and the biological behavior of genes, including the coexistence of EGFR and KRAS mutations, will undoubtedly assist the clinical development of individualized diagnosis and treatment planning.