This is a 54-year-old patient with a history of smoking history abandoned 12 years earlier (20 pack-years) and ankylopoietic spondylitis, who was admitted to our hospital in March 2002 due to a respiratory infection.
No interesting findings were found in the physical examination, including examination of the farino-laryngeal area, general laboratory test and admission diagnosis.
The chest X-ray showed a mass in the posterior segment of the right upper lobe, which in Computerized Tomography (CT) measured 4.4 x 109/ cm and seemed to affect the thorax.
Abdominal examination was normal and sputum smears were negative.
Bronchoscopy was performed, in which the lesion appeared in the described location, well-defined and colorless color.
Since the tumor was easily bleededed, no puncture was performed.
The 11/04 catheter was placed through extrapleural dissection and right upper lobectomy, with resection of hyliomediastinal lymph nodes.
The surgical specimen was reported as a macroscopic tumor of 5x4x4 cm, which histologically corresponded to a poorly differentiated large cell carcinoma lymphoepithelioma-like variant.
The parietal invasion was staged as T3N0M0 (IIb) and resected lymph nodes were negative.
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Between July and September 2002, she received complementary radiotherapy (RT) at the level of mediastinum and pulmonary apex (46 Gy, with over-printing of 20 Gy in the mass contact area with the rectum).
From November 2002 to May 2003, the patient consulted several times for heartburn and dyspepsia.
She was diagnosed with gastroesophageal reflux, hiatal hernia and antral gastritis due to Helicobacter pylori, so she was treated with antibiotics.
In June 2003, due to the persistence of the symptoms, accompanied by abdominal pain and weight loss of 10 kg in these 6 months, abdominal ultrasound was performed, which showed retroperitoneal mass with recurrent gallbladder and retroperitoneal mass with dilation.
Between July and September 2003, the patient received chemotherapy (CT) with Taxotere 40 mg/m2 days 1, 8, and Gemcitabine did not respond to chemotherapy (1250 mg/m2 days, then 8 every 21 days, x 3 cycles, in our
As toxicity, grade 2 diarrhoea after the first cycle.
After two more cycles, in the November/2003 CT scan no changes were observed (NC), so treatment was discontinued, maintaining periodic controls.
In January/2004, due to clinical worsening, a CT was requested in which there was a progression (PE) at the level of the retroperitoneal mass.
A second line was initiated with a scheme used in lymphoepithelioma of cavum, Cisplatin 50 mg/m2 and Capecitabine, instead of 5-Fluoruracil starting at 14 days.
After 4 cycles, with toxicity in the form of nausea grade 2-3, she presented PR in CT, with 3 more cycles.
On June/04 CT scan new PE was initiated, so the third line was initiated with 4-epirubicin 40 mg/m2 days 1.8 every 21 days, for which 4 cycles were administered.
During this period she presented an increase in abdominal pain and PE at CT, with the appearance of lymphadenopathies compressing the left renal vein.
Then, 4th line treatment with Etoposide 50 mg x 20 days was initiated orally and 3 sessions of radiation therapy 6 Gy were administered to the retroperitoneal level, although there was no clinical improvement.
In November 2004, the patient was admitted with anemia, with Hb of 4.9 g/dl, in relation to upper gastrointestinal bleeding.
We transfused 4 Epidermal concentrates and started 5th line with Vinorelbina 25 mg/m2/week.
Until December 2004, she received 3 cycles, during which she remained clinically stable and did not require new transfusions.
In December 2004 she presented a new worsening of symptoms (severe abdominal pain, constitutional syndrome) and anemization, so she was hospitalized, objectifying in this admission several episodes of hematochezia.
Given the poor general condition with K 30%, it was decided not to perform invasive studies and symptomatic treatment, with death in February 2005.
