Arif Salman, Irfan Akmal, Qadri Syed S
Cardiothoracic Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, GBR.
Cureus. 2024 Dec 5;16(12):e75159. doi: 10.7759/cureus.75159. eCollection 2024 Dec.
Non-small cell lung cancer is the most common type of lung cancer globally. An important subtype to discuss is undifferentiated carcinomas, which are variants of large cell carcinoma, and these can typically present with evidence of neuroendocrine differentiation. The patient presented with a large mass in the right upper lobe extending into the middle lobe. It was attached to the pleura and involved the pericardium medially. The biopsy showed poorly differentiated carcinoma. However, pleural origin could not be ruled out. Hence, the patient was planned to have surgical excision followed by adjuvant chemotherapy. The surgical excision involved a video-assisted thoracic surgery (VATS) inspection followed by median sternotomy for medial dissection and then the excision was completed through right posterolateral thoracotomy. The patient recovered well postoperatively and went home on Day 7. The patient is doing well at four months follow-up. It is interesting to know how a large tumour can be managed when the origin of the tumour is not certain and neoadjuvant therapy cannot be utilized to downsize the tumour.
非小细胞肺癌是全球最常见的肺癌类型。需要讨论的一个重要亚型是未分化癌，它是大细胞癌的变体，通常可表现出神经内分泌分化的证据。该患者右上叶有一巨大肿块，延伸至中叶。肿块附着于胸膜，内侧累及心包。活检显示为低分化癌。然而，不能排除胸膜起源。因此，计划对该患者进行手术切除，随后进行辅助化疗。手术切除包括电视辅助胸腔镜手术（VATS）检查，然后进行正中胸骨切开术以进行内侧解剖，最后通过右后外侧开胸完成切除。患者术后恢复良好，于第7天出院。在四个月的随访中，患者情况良好。当肿瘤起源不确定且无法使用新辅助治疗来缩小肿瘤大小时，如何处理这样的大肿瘤是很有意思的。
