Case #1

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Expand Primary Site

Probable left upper lobe of lung.

Expand Physical Exam


Tenderness in region of L 4th rib posteriorly. Patient has history of Ca of R breast in 1971 with right radical mastectomy. Recent bony pelvic pain.

Expand X-Rays & Scans


Chest X-ray: LUL lesion with partial destruction of left posterior 4th rib; cannot rule out L pleural effusion.


Bone Scan: Intense uptake throughout the thoracolumbar spine as well as the pelvis and both femurs due to arthritis; tumor activity at L 4th rib.


Pelvic sonogram: Negative.

Expand Scopes


Thoracoscopy: Approx. 3 cm carcinoma in the LUL; possible malig. pleural effusion (cells swabbed), obvious lytic destruction of the L 4th rib (biopsied) which is direct invasion of the rib from the lung tumor; surgeon states that the tumor is unresectable.

Expand Laboratory


CEA: 670 (normal 0 - 3)
CA 125: 295 (normal 0 - 35)

Expand Operative Findings

None reported.

Expand Pathological Reports


Biopsy of L 4th rib: Anaplastic adenocarcinoma (Note: pathologist suggests that histologic picture is more compatible with pulmonary primary than breast.) Cytology Pleural fluid positive for poorly diff to undiff adenoca

Expand Treatment


Radiation: external beam 3500 cGy to left lung delivered in 250 cGy fractions; Palliative radiation to pelvis.


Chemotherapy: began carboplatin