Metastatic Lung Adenocarcinoma in a Lifetime Nonsmoker With an Atypical Radiological and Clinical Presentation

Lung cancer remains the leading cause of cancer-related deaths globally. While smoking-related lung cancers still account for most cases and cause approximately 100,000 deaths annually in the USA, smoking rates have been declining for decades. Lung cancer in never-smokers (LCINS), which tends to affect women and Asian populations, is now the fifth most common cause of cancer-related deaths worldwide. In 2023, over 20,000 lung cancer deaths in the USA were projected to occur in never-smokers, making LCINS the eighth leading cause of cancer-related mortality in the country. As the number of LCINS cases rises, it becomes increasingly important to explore the unique causes and characteristics of the disease, which calls for tailored diagnostic approaches and personalized treatment plans. Lung adenocarcinoma (LUAD) can present with atypical imaging features that often resemble benign conditions, including pneumonia, lung abscesses, post-infectious scarring, atelectasis, mediastinal masses, emphysema, and granulomatous disease. This variability in presentation can hinder accurate diagnosis and potentially delay timely treatment. While lung cancer is uncommon in younger individuals, with only 5.6% of new cases occurring in those under 54 years old, clinicians should maintain a high index of suspicion, as early detection is essential, and atypical cases can be easily missed. Here, we present a complex case involving an unusual radiologic manifestation of a lung mass, in which tuberculosis was initially considered the primary differential diagnosis.