What happened, in summary

A 75-year-old man was evaluated for a 43 mm left upper-lung nodule without obvious distant spread. He underwent a left upper lobectomy with mediastinal lymph-node dissection. Pathology found two lung tumors in the resected lobe: an invasive adenocarcinoma and a much smaller adenocarcinoma in situ. The invasive cancer had papillary, lepidic and fetal-type areas, and a lobar bronchial lymph node contained metastasis from the fetal-type component. The invasive tumor was classified as Stage II. Molecular testing with the Oncomine Dx panel did not identify a targetable alteration, and PD-L1 testing was negative. No additional anticancer treatment was described after surgery. At 8 months of follow-up, he was doing well and had no evidence of recurrence. The two lesions are kept together because they were synchronous, removed in the same operation, and managed as one integrated lung-cancer episode.