Primary multiple malignant tumors — polyneoplasia are currently among other oncological diseases more than 3% and there is no tendency to their reduction. The formation of independent malignant tumors in various organs occurs simultaneously (synchronously) — up to 6 months, or sequentially (metachronously) —for up to 10 years or more.
Due to the fact that the lungs are one of the organs most often affected by cancer, the probability of primary multiple tumors with their participation is high, making up more than 5% of the total number of patients with polyneoplasia according to I.K. Kim (1979).
According to the materials of pathoanatomical studies performed in persons older than 40 years, this indicator is even higher — 20—%.
Among various combinations of lung cancer with tumors of other localizations, a frequent lesion of the larynx, up to 1.5% of the number of patients with laryngeal cancer, was noted. Tumors of the gastrointestinal tract also occupy a prominent place. The pathogenesis of such polyneoplasia may be due to the common embryogenesis of these organs, which is formed from one germinal leaf. a particularly intense effect on these organs of oncogenic factors of the human environment, which has worsened in recent decades almost everywhere, cannot be ruled out.
The general tendency for an increase in the number of people with a “second” malignant tumor, as it was justifiably noted , can be explained by a significant prolongation of the life of cancer patients who underwent radical treatment in the past and are genetically predisposed to malignant neoplasms.
Morphological changes observed in malignant tumors with primary multiple lesions of the lungs and other internal organs are very diverse. Most often, such tumors by their histological structure belong to highly differentiated types, characterized by a relatively long period of local-regional development and slow growth without a tendency to invasion or wide metastasis. There is reason to believe that with primary multiple cancer and its undifferentiated structure, local, within the affected organ, tumor development for a long time resembles a benign process. Probably, in patients with polyneoplasia, peculiar features of the response of the body’s defenses to the growth of a malignant tumor are formed that inhibit and localize it.
True polyneoplasia, primary multiple lung cancer is not always easy to distinguish from hematogenous metastasis of the tumor in the internal organs.
Of particular difficulty in such a situation is the verification of the nature of the established blastomatous lesion of the lung with a diagnosed cancer of a different location — the stomach, kidney, adrenal gland, prostate gland, mammary gland, etc. Then an assumption usually arises of hematogenous metastasis of such a tumor into the lung.
Recognition of the features of the development of the pathological process in these cases can be helped by some criteria proposed by O. Goetze in 1913.
The most convincing sign confirming the primary
the multiplicity of tumor development in the lung and beyond, in another organ, is morphological — the differences in their histological structure.
It is also believed that the formation of several neoplasms in the lung at the same time, especially in the peripheral parts of the organ, is pathognomonic for extensive hematogenous dissemination into it of a primary tumor of a different localization. With a single rounded formation in the lung, hematogenous metastasis can sometimes be distinguished from the primary peripheral tumor by the absence of a characteristic retraction over it, a reaction of the visceral pleura. The absence of metastasis to the regional lymphatic collectors of the lung also characterizes the hematogenous dissemination of another primary tumor into it, but with some caution: “grandchild” lymphogenous metastases are sometimes probable. At the same time, for primary lung cancer with polyneoplasia, the defeat of regional lymphatic collectors is natural.
In 1975, N. Martini and M. Melamed, for the recognition of lung lesions with polyneoplasia and hematogenous metastasis in them of other primary tumors, suggested several characteristic signs.
So, it is recommended to take into account the inherent occurrence of primary multiple tumors in distant anatomical regions. In this case, the location of each of the primary tumors outside the lymphatic outflow paths from the corresponding region should be evaluated, thereby excluding the likelihood of lymphogenous cancer spread.
With metachron primary multiple cancer, recognition of the second tumor can be helped by changes noted in the past in this organ that fit the definition of “precancer”, “carcinoma in situ”.
An important sign indicating secondary hematogenous metastasis to the lungs of a tumor of a different location, which almost completely eliminates the likelihood of developing primary multiple cancer, is the detection of similar pathological changes in other organs.
The desire to distinguish primary multiple cancer with a lung lesion from a primary cancer of a different location with hematogenous metastasis to the lung in terms of the establishment of pathological changes: in the first case, over two years, and in the second, up to two years, should be treated with caution. In a certain genotype of people predisposed to polyneoplasia, removal of one of the tumors can cause adverse changes in the immune system, leading to the activation, intensive growth and development of a second, latent tumor in the first years and even months after surgery.