Abstract YO32
Case summary
We present a 63 year old Filipino female with chronic back pain accompanied by dyspnea, chest tightness and palpitations. Her past and social history is unremarkable. Her family members had cervical cancer and leukemia. Chest x-ray was unremarkable. 2D echo showed a fixed mass attached to the atrial septum. Cardiac MRI showed a mass centered in the left atrial side of the interatrial septum extending/occluding the right inferior pulmonary vein with possible extension into the right lower lobe of the lung. On Chest CT scan there’s a soft tissue mass at the right anterolateral paravertebral region T10-T11 extending superiorly at the right lower lobe bronchus and medially into the left atrium. Patient initially consulted at different institution where CT guided FNAB was done revealing thymic carcinoma positive for Pancytokeratin and LCA. The patient transferred at our hospital and the team reviewed the workups done. PET scan revealed that there is a right lower lobe mass extending into or from the left atrium, encasing the right lower lobar bronchus and segmental bronchi and abutting the inferior vena cava and distal esophagus. On repeat 2D echo, the right lower lobe mass extends to the left atrium rather than an atrial mass attached to the septum as seen in the PET CT scan. Slide review and immunohistochemistry staining, CK diffusely positive, P40 positive in rare cells. Negative for CD5, CD20, CD117, TTF-1, synaptophysin and chromogranin. Final histopathology result showed that the tumor may be classified as Non-small cell carcinoma, not otherwise specified. The patient was negative for targetable mutations. PD-L1 testing showed 50 to 60%. She was assessed with a final diagnosis of Non-Small Cell Lung Cancer, NOS, St. IV Driver Negative PD-L1 50-60% with Paravertebral Metastasis and Neural Canal Compression. She underwent palliative radiation for the back pain. But due to the aggressiveness and local extension of the right lower lobe mass, atrial fibrillation complicated the patient’s hospital course. The patient underwent systemic chemotherapy (Paclitaxel-Carboplatin-Pembrolizumab) and radiation therapy after controlling the atrial fibrillation.