Lung Cancer: Solitary Pulmonary Nodule

Abstract

A 55-year old, middle-aged man, known for hypertension and dyslipidemia, presented to the OPD with complaints of fever along with a mild dry cough. There was no shortness of breath or chest pain associated with the patient’s complaints. Therefore, as a seemingly obvious diagnosis, he was suspected of having a COVID-19 infection.   The man has a positive smoking history of approximately 20 cigarettes per day for 25 years. However, his COVID-19 PCR tests provided two negative results. His chest X-ray was also unremarkable. Apart from some abnormalities in his laboratory analyses, which have been discussed in detail in the coming sections, there seemed to be nothing unusual or out of place with the patient. However, when a CT scan without contrast was ordered for the patient, the report showed a mass that was approximately 23 x 21 x 16 mm in size. The mass had a soft, tissue-like consistency. It also appeared to have irregular, lobulated margins. This entire mass was seen to be present in the anterior segment of the upper lobe of the left lung. Apart from this mass, no COVID-19-related consolidations or signs of respiratory distress were seen in this patient. When the mass was confirmed, a needle-core biopsy was done to find out the nature of it. The biopsy report confirmed that the mass was indeed a moderate-to-poorly differentiated non-small cell carcinoma of the lung, which was consistent with adenocarcinoma with sarcomatoid features.  All these aspects of the tumor, with radiological evidence, have been discussed below. The patient is being supportively managed as of now and is also being kept on a follow-up schedule. What's worth mentioning, however, is that despite such minor symptoms, the underlying problem could still be serious. If the patient had not gone for an X-ray or CT for their suspected COVID-19 abnormalities, then their case would not have come to a diagnosis and it would have eventually taken a turn for the worse. The whole case, along with the findings and the patient response has been discussed throughout this paper.