Case presentation
A 73-year-old previously healthy male patient presented to the emergency
department due to a productive cough, and shortness of breath for
several months. He has been working as a mechanic for many years, and
recalled no family history of cancer.
Upon admission, the physical assessment revealed right upper chest and
lower sternal tenderness as well as vesicular breathing and expiratory
wheezes. A reducible inguinal hernia was also noted. The laboratory test
results were in normal ranges. Upon that, chest x-ray revealed right
upper lobe consolidation (Figure 1).
For that reason, a scan with contrast was performed, which showed a
right upper lobe cavitary lesion with a thick wall adjacent to the
ipsilateral pleural surface measuring about 5x5 cm as well as
pathologically appearing multiple hilar mediastinal and single right
axillary lymph nodes. Vertebral pedicle lesions and two hypo-enhancing
liver lesions were also seen (Figures 2–3).
The multidisciplinary team (MDT) meeting decided that a biopsy should be
taken from the hepatic lesion at segment VI and from the right axillary
lymph node. The result of the histopathology report was diagnostic for
metastatic poorly differentiated squamous cell carcinoma consistent with
lung origin. In light of our findings, the patient began immunotherapy.