The patient is a 71 year old woman, who has been a former smoker for 25 years, is diagnosed with hypertension, polymyalgia rheumatica and temporal arteritis.
In 1988, following a study for metrorrhagia, an endometrial tumour was detected and a hysterectomy and double adnexectomy were performed. The pathology study showed that it was a well-differentiated adenocarcinoma (grade I), with infiltration of the inner third of the myometrium, without evidence of infiltration of blood or lymphatic vessels, with a negative extension study, therefore stage Ib. She subsequently received radiotherapy with cobalt-60 in the pelvis and brachytherapy in the vaginal vault. She underwent periodic check-ups with no evidence of relapse.
In 2003, she consulted for irritative cough and slight haemoptotic expectoration, and a simple chest X-ray showed a mass in the left upper lobe. With the suspicion of a bronchogenic neoplasm, the studies were completed and a thoracic-abdomino-pelvic CT scan was performed, showing a necrotic mass measuring 8 cm in the LSI with atelectasis of this lobe with no other alterations. Bronchoscopy was performed which revealed a tumour in the anterior segment of the aforementioned lobe, the BAS and bronchial biopsy being compatible with poorly differentiated squamous cell carcinoma.
With the clinical diagnosis of T2 N0 M0 squamous cell carcinoma of the lung, it was decided to start neoadjuvant chemotherapy, with the scheme Carboplatin (AUC 6) plus Paclitaxel (200mg/m2) every three weeks. After three cycles of treatment, a partial response was observed in radiological studies and the patient underwent left upper lobectomy and lymphadenectomy. Analysis of the surgical specimen showed a tumour corresponding to adenocarcinoma with poorly differentiated areas, with some squamous areas, with positive immunohistochemical results for oestrogen and progesterone expression, and negative for TTF-1 and CK20. These confirmatory results changed the initial approach, as it was not a primary pulmonary tumour as previously thought, but a pulmonary relapse of her endometrial tumour.
The patient is being treated with megestrol acetate, with good tolerance, free of disease and is currently being followed up.