SHM Converge Scientific Abstract ePoster Gallery-Non-Small Cell Lung Cancer With Miliary Patterning: A Case of Virtually Asymptomatic Stage Iv Lung Adenocarcinoma

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This case describes a previously healthy 45-year-old never-smoker who presented with one month of exertional shortness of breath, a dry cough, and a 25-pound unintentional weight loss over six months. Despite severe hypoxemia at urgent care, he appeared relatively well and could speak in full sentences on exam. Initial labs showed inflammation and mild abnormalities, but an extensive infectious workup was largely negative.<br /><br />Further evaluation revealed lung adenocarcinoma of lung origin, confirming stage IV non-small cell lung cancer (NSCLC). Biomarker testing was notable for negative PD-L1 expression, which limited immunotherapy options and suggested a poorer prognosis. Imaging demonstrated extensive metastatic disease, including more than 60 brain metastases, as well as spread to the bone, liver, and left adrenal gland.<br /><br />The patient underwent palliative whole brain radiation and tolerated treatment well. Remarkably, he remained largely asymptomatic aside from shortness of breath despite the burden of widespread metastatic cancer. He was later discharged home and subsequently died.<br /><br />The discussion emphasizes that NSCLC, especially adenocarcinoma, is the most common lung cancer subtype in nonsmokers. It also highlights the importance of tumor biomarkers in guiding prognosis and treatment. Better outcomes are associated with early-stage disease, limited weight loss, good functional status, and certain biomarker profiles such as EGFR or ERCC1 positivity. In contrast, K-ras expression and lack of PD-L1 expression are associated with worse outcomes.<br /><br />Overall, this case underscores that malignancy should remain in the differential diagnosis for respiratory complaints, even in younger nonsmokers with minimal symptoms, because advanced lung cancer can present deceptively subtly.

Asset Subtitle

Becca Parr

Meta Tag

Author List Aamina Ahmad, Becca Parr, Melissa Olken

Category Clinical Vignettes

Concept Non-Small Cell Lung Cancer

Concept Adenocarcinoma

Concept Differential Diagnosis

Concept Stage

Concept Biomarker Status

Distinguished Non-Finalist

Presenter Organization Western Michigan University MD School of Medicine

Presenting Author Becca Parr

Track Adult

Keywords

non-small cell lung cancer

lung adenocarcinoma

nonsmoker

PD-L1 negative

brain metastases

metastatic disease

hypoxemia

weight loss

whole brain radiation

tumor biomarkers

Non-Small Cell Lung Cancer

Adenocarcinoma

Differential Diagnosis

Stage

Biomarker Status