Small-cell lung cancer with lymphadenopathy in an 18-year-old female nonsmoker.

BACKGROUND

An asymptomatic 18-year-old female presented in December 2002 with a left pulmonary mass, and an enlarged mediastinum and left hilum, detected on a routine chest X-ray. She had never smoked, and had no history of exposure to known carcinogens, no history of serious illnesses and no family history of malignancy. Superficial lymph nodes were not palpable. A CT scan of the chest disclosed a round tumor in the left lower lobe and marked enlargement of the ipsilateral hilar and mediastinal lymph nodes.

INVESTIGATIONS: CT scan of the chest, routine hematological study, sputum smear and culture for acid-fast bacilli, transbronchial lung biopsy, serum tumor markers, CT scan of the abdomen, MRI scan of the head, bone scintigraphy, lung function tests, blood gas analysis, pathological examination including hematoxylin-eosin staining and immunohistochemistry using chromogranin A, CD56 (neural cell adhesion molecule), and cytokeratin antibodies.

DIAGNOSIS: Limited-stage small-cell lung cancer (T1N2M0, clinical stage IIIA).

MANAGEMENT: Etoposide plus cisplatin chemotherapy with concurrent accelerated hyperfractionated thoracic radiotherapy, left pneumonectomy and lymph-node dissection.