Photo Rounds

Mass on upper chest

A 60-year-old woman asked her family physician (FP) to look at the solid, nontender, movable mass on her upper chest that had been there for 6 months. She had lost 10 pounds over the last year without dieting and her “smoker’s cough” (she smoked a pack of cigarettes a day since age 18) had recently gotten worse. She now occasionally coughed up blood-tinged sputum. The FP excised the mass and sent it to Pathology.

What's your diagnosis?


The pathology report indicated that the patient had squamous cell carcinoma (SCC) of the lung, a diagnosis that was consistent with an x-ray and computed tomography (CT) scan that were also done.

Lung cancer is a malignant neoplasm of the lung arising from the respiratory epithelium (bronchi, bronchioles/alveoli). The 4 major cell types responsible for 88% of cases are:

○ adenocarcinoma (including bronchoalveolar)—32% of cases

○ squamous cell carcinoma—29% of cases

○ small cell (or oat cell) carcinoma—18% of cases

○ large cell (or large cell anaplastic)—9% of cases.

Smoking is the major risk factor for lung cancer; a smoking history (current or former) is present in 90% of cases, with a risk ratio (RR) of 13 (passive smoke exposure has a RR of 1.5). Skin nodules from lung cancer metastases may not be painful but are a poor prognostic sign.

Any time spent helping your patients quit smoking may help avert a fatal outcome. In this case, the patient opted not to receive treatment. She passed away 10 months later.

Photos courtesy of Leonard Chow, MD, Ross Lawler, MD, and David Kasper, DO. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Lung cancer. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:355-364.

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