Catherine Jordan
We report a case of an 82-year old Filipino male who initially presented with chronic cough, weight loss, and hemoptysis. Work-ups lead to a diagnosis of metastatic non-small cell carcinoma, favoring adenocarcinoma, in a subcarinal lymph node that was compatible with a pulmonary primary. There was persistence of symptoms and severe atelectasis, which prompted clinicians to perform rigid and repeat flexible bronchoscopy with Holmium laser ablation to debulk the endobronchial mass. Our patient had a non-small cell carcinoma with pleomorphic features stage IV (cT4 N0 M1c) with bone, brain and pleural metastases. Biomarker testing did not show EGFR mutation, ALK was negative and PDL-1 immunohistochemistry showed tumor proportion score of 20-30%. He received one cycle of Pemetrexed therapy. However, he expired on the 39th hospital day due to acute right cerebellar and left parieto-occipital hemorrhage. The recognition of this rare histologic subtype is important because of its generally aggressive nature and limited treatment options.
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