246 Chapter 16 cancer and metastasis, metastases of breast cancer were suspected, due to a right breast mass and regional lymphadenopathy, but further diagnostic testing was not pursued because of her dismal clinical condition. She passed away, and the cause of death was attributed to a metastasized second primary malignancy, most likely breast cancer, based on radiology. Her status related to the initial tumor was therefore, also considering the 6 years’ time interval classified as “death, no evidence of disease” (DND). Case 4 In 2011, a man aged 68 underwent a resection of his right lower lobe for a pneumonialike tumor > 15 cm. The histology of the whole lobe revealed a non-invasive tumor with lepidic growth pattern. In 2013, the middle and upper lobe were resected, with the middle lobe showing a non-mucinous lepidic adenocarcinoma of 12 cm without any invasive areas. The upper lobe exhibited an lepidic area of 2 cm, similar to that of both tumors in the lower and middle lobes which had the same KRAS mutation. No treatment was initiated. In 2014, he underwent stereotactic radiotherapy for a growing ground-glass lesion in the left lower lobe without solid areas. Following this, multiple ground-glass lesions developed in the left lung. In 2016, he began chemoradiation with a platinum-based regimen. In 2017, he was transferred to a different hospital for experimental immunotherapy, after which chemotherapy was discontinued. However, a year later, immunotherapy was stopped, and chemotherapy was resumed. The lesions have remained relatively stable. Ten years after his initial resection, the status of his initial tumor was classified as “alive with no evidence of disease” (AND). Case 5 In 2011, a man aged 65 underwent a left upper lobectomy for a 17 cm tumor found on CT. The gross specimen at pathology revealed a recognizable tumor of 9 cm, consistent with a more solid area of about 10 cm seen on radiology. Both this area as well as the ground glass areas surrounding this, but on gross examination non-remarkable were histologically classified as a lepidic growth pattern and therefore non-invasive adenocarcinoma. Approximately 1 year later, consolidations in the left lower lobe were found and on biopsy adenocarcinoma with a lepidic growth pattern was diagnosed. The patient received treatment with radiotherapy and angiogenesis inhibitors. In mid2014, after a 2-year interval, progressive bilateral lung densities emerged with groundglass morphology. In the beginning of 2015 the areas became denser, and the patient passed away without establishing the nature of the lung lesions, however, these were presumed metastases or invasive areas from the second primary lung malignancy in the left lower lobe. His status was for his primary tumor was established as “death, no evidence of disease” (DND).
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