A 70-year-old Caucasian female presented with mild dyspnea and no chest pain.
She has also experienced recent, rapid weight loss (>10 pounds in 1.5 months) without any changes in her diet or exercise pattern.
She gave up smoking 7 years ago (2 packs per day for 35 years).
Her medical history is unremarkable:
A few years ago, she was diagnosed with gastroesophageal reflux disease that was clinically and endoscopically confirmed.
She has no history of cancer in the family.
Her cardiac workup is negative.
Her PS by ECOG assessment was 0.
Chest x-ray showed a 2.5-cm lesion in her right lower lobe.
CT scan of the chest and abdomen confirmed the presence of the lung mass in addition to numerous bilateral nodules, all about 5 to 9 mm, in the right upper and lower lobes and the left upper and lower lobes, as well as enlargement of hilar lymph nodes. In addition, 3 small nodules were seen in the liver, measuring 1 to 2 mm.
PET/CT imaging showed 18F-FDG uptake in the lung mass, left hilar lymph nodes, and liver.
MRI of the brain was negative for intracranial metastases.
A core biopsy of the lung nodule was performed:
Its morphology and molecular phenotype (TTF-1-positivity) supported a diagnosis of lung adenocarcinoma.
Mutational testing showed absence of driver mutations (i.e., was negative forEGFR, ROS, andALK).
PD-L1 testing showed PD-L1 expression of 35%.
The patient was diagnosed with stage IV metastatic NSCLC.
The patient was started on therapy with a chemotherapy doublet and bevacizumab (Avastin).
At her next follow-up 2 months later, her CT scan showed the right lung mass to be stable, with no new lesions. She has improved symptomatically.