April 18, 2017

March 2017

  • A 70-year-old female presents with shortness of breath and right-sided chest pain of 3 months’ duration
  • She has a 25-year (1-pack/day) smoking history
  • Chest X-ray revealed a pathologic fracture of the right 4th rib and a large right-sided pleural effusion
  • CT scan confirmed the presence of a 3 cm spiculated mass in the right upper lobe, moderate right pleural effusion, and multiple lytic lesions in the spine and ribs
  • Core needle biopsy of the lung mass was performed
    • Pathology showed poorly differentiated lung squamous cell carcinoma, p63+ and CK5/6+ with abundant cytokeratin
    • Genetic testing was negative for known driver mutations
    • PD-L1 testing by IHC showed expression in 20% of cells
  • The patient received palliative radiation therapy to the rib
  • Options for systemic therapy are under discussion