Adenocarcinoma of the Lung in a 67-Year-Old Man
A 67-year-old man with a 5-month history of cough, shortness of breath, and pain in the left anterior chest wall sought medical evaluation. The patient denied fever, chills, and hemoptysis. He reported a recent weight loss of 25 lb. The patient had smoked cigarettes for 37 years.
A 67-year-old man with a 5-month history of cough, shortness of breath, and pain in the left anterior chest wall sought medical evaluation. The patient denied fever, chills, and hemoptysis. He reported a recent weight loss of 25 lb. The patient had smoked cigarettes for 37 years.
Sonia Arunabh, MD, and Kanwar Rauhila, MD, of New Hyde Park, NY, noted a left upper lobe mass on a chest film. The mass was clearly demonstrated on a CT scan of the chest (A, arrow). Adenocarcinoma of the left upper lobe of the lung was confirmed by a CT-guided biopsy. The CT scan also showed a slight left pleural effusion; abdominal CT scans revealed a metastatic lesion in the liver (B, arrow) and lesions in both the adrenal glands (C, arrows).
Adenocarcinoma is the most common type of lung cancer in the United States. Metastases can occur in virtually any organ or tissue; the most frequently affected sites beyond the thorax are the lymph nodes, liver, adrenal glands, bone, and brain:
- Lymph node metastases result in palpable supraclavicular and axillary nodes.
- Metastases in the liver can cause dysfunction and biliary obstruction and pain.
- Although much of the adrenal gland may be replaced by metastatic malignancy, clinical manifestations of adrenal insufficiency do not commonly occur.
- Bone metastases can cause pain and pathologic fractures, and bone marrow invasion may lead to cytopenias. In addition, spinal cord compression syndromes can result from epidural or bone metastases.
- Brain metastases may be associated with neurologic deficits.
Paraneoplastic extrathoracic manifestations of lung cancer that are not related to metastases include hypercalcemia in patients with squamous cell cancers, hyponatremia in those who have small-cell cancers, myopathy, and thrombotic and cutaneous manifestations.
The prognosis for patients with metastatic lung cancer is guarded. This patient underwent radiotherapy and chemotherapy; he died of progressive metastatic disease 5 months after presentation.
