Authors
William Le, Megana Tirupathi, Luke Oh, Michael Diaz, Sreelatha Tirupathi
Published in
Cureus. Volume 18. Issue 7. Pages e112412. Epub Jul 10, 2026.
Abstract
Combined lung carcinomas containing both non-small cell and high-grade neuroendocrine components are rare and diagnostically challenging due to intratumoral heterogeneity. We report a 61-year-old never-smoking woman with pleuritic chest discomfort and chronic cough. Computed tomography (CT) and positron emission tomography (PET)/CT demonstrated a left upper-lobe pulmonary nodule with intensely FDG-avid hilar and mediastinal lymphadenopathy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of FDG-avid lymph nodes was nondiagnostic. Given persistent clinical and radiologic concern for malignancy, the patient underwent video-assisted thoracoscopic surgery (VATS) for definitive diagnosis. Pathology revealed a rare triple-component malignancy composed of adenocarcinoma, large-cell neuroendocrine carcinoma, and small-cell lung carcinoma, with metastatic neuroendocrine carcinoma involving mediastinal lymph nodes and pleura, consistent with stage IVA disease. The patient was subsequently treated with platinum-etoposide-based systemic therapy, with immunotherapy planned as part of her treatment course. This case highlights that nondiagnostic minimally invasive sampling does not exclude malignancy and underscores the importance of radiologic-pathologic concordance, awareness of sampling limitations, and timely escalation to additional tissue acquisition, including surgical biopsy when appropriate.
PMID:
42572645
Bibliographic data and abstract were imported from PubMed on 10 Aug 2026.
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