- A 72-year-old female presented to her primary care physician with symptoms of shortness of breath and increased cough.
- The patient has a 40-year (1 pack/day) smoking history.
- Chest X-Ray revealed a right upper lobe opacity.
- CT of the chest and abdomen showed a 3 cm. right upper lobe mass, pleural thickening, and a left adrenal gland nodule.
- She underwent core needle biopsy, the left adrenal mass showed squamous cell carcinoma that was p40+ and p63+.
- PET/CT indicated stage IV squamous cell lung cancer.
- The patient began chemotherapy with carboplatin/nab-paclitaxel.
- CT after 2 cycles of therapy indicated that her tumor burden decreased significantly. At that point the patient reported improvement of her symptoms.
- After 6 cycles the patient had stable disease.
- Routine follow up imaging showed a new left upper lobe mass of 2 cm.
- The lung lesion was biopsied and confirmed to be of squamous cell histology.
- Based on multidisciplinary assessment, the new lung lesion was treated with stereotactic radiosurgery.
- The patient reported symptoms of coughing and shortness of breath.
- CT showed increased diameter in both lung masses. The adrenal mass remained stable.
- The patient was subsequently started on nivolumab.