How to Manage a Large Undifferentiated Lung Cancer Mass: A Case Report

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.