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65-Year-Old Man with Rare Presentation of Lung Cancer

A 65-year-old male with a 40 pack-year smoking history presents with a dry cough that is sometimes accompanied by blood in the phlegm. His medical history is unremarkable.

His physical exam detected a rough respiratory murmur from each lung. Lab results were normal, except for an elevated PSA ( ng/ml).

A chest CT revealed the presence of a 9.2 cm irregular-shaped soft mass in his right lobe, adjacent to his pulmonary hilum, and a high-density shadow, approximately 2.7 cm in diameter, in his lower left lobe. The mediastinal lymph node was positive, suggesting metastatic disease.

A fiber bronchoscopic biopsy showed SCLC in the right lobe and squamous cell lung cancer in the left lobe. Immunohistochemical staining revealed significant positivity for AE1/AE3 for the squamous cell tumor; the small cell tumor was negative for CgA(-), NapsinA, and p40.

Would additional testing be necessary to develop a treatment plan?
What are the additional challenges in treating a patient with synchronous disease?