Robert Chen, MD

A 62-year-old man with a 40-year history of smoking presented with shortness of breath and weight loss. Initial chest X-rays were unremarkable and the patient subsequently underwent full body CT scan in search of a primary malignancy. CT scan demonstrated a large central mass in the left lower lobe inseparable from the hilum. There was complete encasement of the left pulmonary artery and left mainstem bronchus, with postobstructive consolidation in the left lower lobe. Incidentally noted were multiple hypodense masses scattered throughout the liver, which were interpreted as metastases from a primary lung carcinoma. A biopsy of the lung revealed small cell lung cancer; a PET scan/CT study was requested to stage the full extent of disease.

A 76-year-old woman was referred to oncology with new palpable left axillary lymph node. Her past medical history was significant for marginal zone lymphoma that was diagnosed in 1999 (received chemotherapy), hypertension and type 2 diabetes. Her ECOG performance status was 2 and physical exam was significant for 1.5 cm left axillary lymph node. Her labs showed white blood cell count of 5.9, hemoglobin of 13.4, platelets of 232, Bun/Cr 22/0.9 and LDH 574.