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.