Small Cells, Big Problems

A 55-year-old man presented to his family doctor with a chronic cough and recurrent pneumonia. Chest X ray indicated an abnormality in the left upper lung zone. A subsequent computed tomography scan of the thorax demonstrated a left upper lobe mass measuring 4 × 7 cm with mediastinal adenopathy (Fig. 1A). Endobronchial ultrasound-guided biopsy showed small cell carcinoma. On pulmonary function testing, forced expiratory volume in 1 second was 83% of predicted, forced expiratory volume in 1 second/forced vital capacity was 0.75, and corrected diffusing capacity of the lungs for carbon monoxide was 86% of predicted.

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