Medically reviewed by Dr. Samuel Sarmiento, M.D., MPH on Oct. 4, 2023
A recent case report describes an atypical presentation of liquified lung cancer in a 71-year-old female.
In this article, we examine a case study published in the journal Frontiers in Oncology of a 71-year-old female with a history of lung cancer. This case highlights the complexities and diagnostic challenges often associated with the condition.
Baffling Lung Cancer Symptoms Summary
A 71-year-old female patient arrived at an emergency department with complaints of worsening shortness of breath and a productive cough. She had a history of stage IV squamous cell carcinoma of the lung and multiple medical comorbidities.
Upon arrival, she was hypoxic and placed on oxygen therapy. Her vital signs indicated sinus tachycardia, high blood pressure, and an elevated respiratory rate. Physical examination revealed wheezing and decreased air entry.
Given her history, a CT scan of the chest was performed to rule out pulmonary embolism. The scan revealed adenopathy, soft tissue in the left bronchus, and complete collapse and consolidation of the left lower lobe due to obstruction.
The patient’s labs showed leukocytosis, anemia, reactive thrombocytosis, elevated D-dimer, hypercalcemia, and elevated lactic acid.
Admitted for post-obstructive pneumonia, she received antibiotics, but her condition worsened. A follow-up CT of the chest was performed 4 weeks later, which indicated the pulmonary masses had increased in size. Infectious workups were negative, and a biopsy revealed liquified material containing WBCs and extensive necrotic material along with highly atypical degenerating epithelial cells suggestive of squamous cell carcinoma.
Despite attempts at intervention, her health deteriorated, with worsening hypercalcemia, metabolic encephalopathy, and other complications. The patient was transferred to hospice care due to her declining condition.
Unraveling a Rare Phenomena
The presented case highlights the intricate and concerning nature of necrosis in lung cancer, particularly the implications of vascular involvement by tumor cells and bronchial obstruction leading to ischemia, which significantly contributes to the poor prognosis often associated with such cases. Notably, the occurrence of necrosis is more frequently observed in squamous cell carcinomas, as seen in this instance.
The presence of cavitary lesions, manifesting as bubble-like formations in adenocarcinomas or thin-walled lesions in squamous cell carcinomas, illustrates the diverse ways in which lung malignancies can manifest.
In the presented scenario, the patient initially presented with symptoms that mimicked an infectious process due to the liquefied nature of the lung malignancy. However, further investigation led to the diagnosis of bronchial obstruction as the underlying cause of her symptoms.
As demonstrated in this case, the interplay between vascular involvement, necrosis, and bronchial obstruction can present diagnostic and management challenges, especially when faced with complications and limited treatment options.
Javed, N., Lee, S., Bojja, S., Tiwari, U., & Khaja, M. (2023). Liquefied lung cancer: an uncommon form of squamous cell carcinoma of the lung. Cureus,15(7), e41848. https://doi.org/10.7759/cureus.41848