A rare case of bronchogenic carcinoma is presented in which the tumor metastasized to lymph nodes already involved by malignant lymphoma.

DEBA P. SARMA, MD*,GERALD E. LIUZZA, MD**

'Associate Professor of Pathology, LSU School of Medicine, and Staff Pathologist, V.A. Medical Center, New Orleans. "Department of Pathology, LSU School of Medicine, New Orleans.

The occurrence of multiple primary cancers in the same person is not uncommon. However, the metastasis of one cancer to another cancer continues to be a rare event. We are describing such an event where a bronchogenic carcinoma metastasized to regional lymphomatous lymph nodes.

Case Report

A 78-year-old man was diagnosed as

having an epidermoid carcinoma of the left lower lobe of the lung in July, 1979, after a left hilar mass was incidentally discovered on chest roentgenogram. There was no evidence of distant metastasis. Because of the apparent mediastinal involvement by the tumor and the old age of the patient, he was treated with 5,100 rads of cobalt 60 over a three-week period. There were no significant complications. The patient returned to the hospital in January, 1980, with fever up to 103F, cough, and dyspnea of several days' duration. Roentgenograms of the chest revealed infiltrates in the left lung. Pertinent laboratory tests showed a white blood cell count of 23,300/cu mm with 83% neutrophils and 7% band forms. A diagnosis of pneumonia was made. The patient expired within 24 hours of admission. At autopsy, a squamous cell carcinoma was found to involve the upper lobe bronchus (Fig. 1) and to extend into the

surrounding lung parenchyma. Bronchial and mediastinal lymph nodes were grossly involved by the tumor. On microscopic examination, lymph nodes showed a diffuse malignant lymphomatous infiltration, the neoplastic cells being mainly lymphocytes mixed with some histiocytes. Two of these lymph nodes also contained metastatic squamous cell carcinoma (Fig. 2). Metastatic carcinoma was also seen in the right lung and in the liver. The liver was enlarged (2500 gms). Numerous tumor nodules of both squamous cell carcinoma and malignant lymphoma (Fig. 3) occupied most of the liver tissue. Bone marrow and lymph nodes from other areas were free of tumor.

Fig. 1 - Squamous cell carcinoma of the bronchus (H&E, original magnification

Fig. 2 - Lymph node showing malignant lymphoma with metastatic squamous cell carcinoma (upper left side). (H&E, original magnification x60)

Fig. 3 - Liver showing metastatic squamous cell carcinoma (right) and malignant lymphoma Geft). (H&E, original magnification x60)

Discussion
The average rate of occurrence of multiple primary malignant neoplasms at autopsy is 5% as observed by Hadju and

Hadju.1 In their study of 177 cases of multiple primary neoplasms, a second primary neoplasm was found in 10% of the patients with lung cancer. The three most common primary tumors in the lung cancer patients were prostate, colon, and kidney. Mersheimer, et al, found additional malignancies of lymphatic and hematopoietic tissues (excluding leukemias) in 3.2% of 95 cases of primary lung cancer. 2 On the other hand, Moertel and Hagedorn observed only one case of lung cancer among 68 cases of malignant lymphoma.3 Cancers of the stomach, 4 cecum,5 and breast6 have been reported to have metastasized to lymph nodes already involved in a lymphomatous process. We did not find any reported case such as ours in which a bronchogenic carcinoma metastasized to lymphomatous lymph nodes. Our case also illustrates the point that lymphoma involving lymph nodes does not completely distort the lymphatic drainage through them because carcinoma still metastasized to the lymphomatous nodes.

Summary
A rare case of bronchogenic carcinoma is presented in which the tumor metastasized to lymph nodes already involved in malignant lymphoma.
References 1Hadju SI, Hadju EO: Multiple primary malignant tumors. J Am Geriatr Soc 16:16-26, 1968 2Mersheimer WL, Ringel A, Eisenberg H: Some characteristics of multiple primary cancers. Ann NY Acad Sti 114:896-921, 1964 3 Moertel CG, Hagedorn AB: Leukemia of lymphoma and coexistent primary malignant lesions: a review of the literature and a study of 120 cases. Blood 12:788-803, 1957 4 Jernstrom P, Murry G: Synchronous double primary lymphosarcoma and-adenosarcoma (collision tumor) of the stomach with cancer-to-cancer metastasis. Cancer 19:60-66, 1966 5 Rabson SM, Stier PL, Baumgartner JC, Rosenbaum D: Metastasis of

cancer to cancer. Am J Clin Pathol 24:572-579,1954 '6Wollam GL, Beahrs OH, Van Vliet PD: Adenocartinoma of the breast metastatic to malignant lymphoma. JAMA 195:963-965, 1966

J La State Med Soc. 1981 Dec;133(12):191-2.

Bronchogenic carcinoma metastatic to malignant lymphoma.

Sarma DP, Liuzza GE. PMID: 7343632 [PubMed - indexed for MEDLINE] Sarma DP, Liuzza GE. Bronchogenic carcinoma metastatic to malignant lymphoma. J La State Med Soc. 1981 Dec;133(12):191-2. PubMed PMID: 7343632

965, 1966