Left upper lobe, lung
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Patient admitted because of mass in LUL. On hyperventilating and forced exhaling, wheezing can be initiated toward lower aspects.
CT chest: Nodular density in left upper lobe; 1.2 cm paratracheal LN to the R of midline. 1.5 - 2 cm lesion situated in the anterior segment of left upper lobe pointing towards left hilum.
Bone scan: Negative.
CT liver: Negative.
Chest: 3 x 3 cm mass in left upper lobe consistent with carcinoma.
Mediastinoscopy: Inflammatory hyperplasia of mediastinal lymph nodes.
Thoracotomy and lobectomy: 3 x 3 cm mass in subapical region leaning towards anterior segment; does not invade the pleura; several surrounding LNs are enlarged.
Gross: LUL mass, L ant hilar LN, L subcarinal LN, and LUL.
Micro: Mod to poorly diff adenoca, lung tissue and 2 peribronchial LNs; LUL mass = 2.5 cm mod to poorly diff adenoca with invasion of the pulmonary vein within the tumor mass, but not extending out from the mass. Bronchial margins are free.
Surgery: Left thoracotomy and left upper lobectomy.
Chemotherapy: began paclitaxel, carboplatin.