FIGURE 8.

Cyst-related lung malignancies as metachronous or synchronous second primary lung cancers. a–e) Two patients with stage IV lung cancer with a large mass in the right upper lobe. Additional cyst-related lesions were present in other lung lobes. These lesions were persistent and highly suggestive of additional primary cyst-related lung malignancies; however, they were not pathologically proven due to the fact that results would not change treatment strategy in these patients. f) A third patient showed a large cystic airspace with irregular wall thickening in the right lower lobe, initially misinterpreted as a large cavitation with aspergillus. Perioperative frozen section showed a pleomorphic carcinoma in the right lower lobe. A metachronous solid nodule was present in the right middle (not shown). Only the solid component of the cyst-related lesion in the right lower lobe was resected, because neither lobectomy or bilobectomy was an option due to limited pulmonary capacity. g) After 1 year local recurrence was present together with persistent mass in the right middle lobe. h) A small cyst-related lesion in the right upper lobe was initially present, but, not acknowledged. This lesion showed an increase in wall thickness over time (not shown). All three lesions showed activity on a positron emission tomography-computed tomography scan obtained to confirm local recurrence.