An atypical presentation of a carcinoma

ABSTRACT We report a case of a 28-year-old male non-smoker with complaints of shortness of breath, fever, and chest pain. He had a history of unilateral progressive swelling and pain in his left upper limb. On physical examination, ipsilateral cervical lymphadenopathy on the left side of the neck was seen. Chest X-Ray showed bilateral pleural effusion with cardiomegaly. Contrast Enhanced Computer Tomography neck angiography showed the presence of thrombus in the Left Internal Jugular Vein, External jugular vein, brachiocephalic and subclavian vein. CT revealed a mass lesion in the right lower lobe. Additionally, lytic lesions were noted in D1 to D4 vertebral bodies, suggestive of metastasis. Diagnostic thoracentesis revealed malignant cells in the pleural fluid. Cervical lymph node biopsy was sent for IHC (Immuno Histo Chemistry) markers, which were positive for lung adenocarcinoma. The patient was diagnosed with stage IV lung adenocarcinoma with metastasis to the left upper limb, cervical lymph nodes, vertebrae, and pleura. The patient was started on palliative chemotherapy and underwent thoracentesis, pericardiocentesis, and pleurodesis to alleviate his symptoms.