Advanced metastatic lung cancer

Case contributed by Dr Bruno Di Muzio


Presented in ED with intense dyspnoea.

Patient Data

Age: 84-year-old

Chest radiographs

Multiple pulmonary nodules bilaterally scattered. There is a large pleural mass with well-defined limits on the right chest lateral midzone, measuring up to 13 cm in its larger axis. Small pleural effusion on the left. Cardiomediastinal contours are otherwise unremarkable. No evidence of pneumothorax or subphrenic free gas.


CT Chest

There are innumerable soft tissue lesions in both lungs, with some extending into the adjacent pleura. The largest is located in the right middle zone, has ill-defined central areas of hyperdensity. It extends into the right lateral thoracic wall, with permeative bone destruction in the right 3rd and 4th ribs. On the left, there is a large loculated pleural effusion causing compression of the interposed left lower lobe. Two bulky adrenal lesions probably represent further metastases. Bilateral hydronephrosis. Within the limits of a noncontrast study, the imaged portions of the liver, gallbladder and spleen are unremarkable. No evidence of bony metastasis. 

Case Discussion

Advanced, metastatic lung cancer with likely distant adrenal metastases, pleural involvement and right chest wall invasion. Likely T4,N2,M1b

MICROSCOPIC DESCRIPTION: The smears contain scattered malignant cells occurring singly, in groups and occasional large loose clusters, in a background of scattered degenerate malignant cells, pulmonary macrophages, acute inflammatory cells and acellular debris. The malignant cells are large with a pleomorphic hypochromatic chromatin pattern, prominent nucloli and abundant foamy cytoplasm.

DIAGNOSIS: Sputum: Undifferentiated large cell carcinoma.

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Case information

rID: 48910
Published: 12th Nov 2016
Last edited: 16th Jul 2018
System: Chest
Tag: rmh
Inclusion in quiz mode: Included

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