What happened, in summary

This 67-year-old East Asian man was referred after routine imaging found a right lower-lobe lung lesion. He had a family history of lung and nasopharyngeal carcinoma. CT and PET-CT showed a 4.6 × 3.7 cm lesion in the right lower lobe, along with right middle-lobe bronchiectasis and mild inflammatory changes, with no distant metastases. Bronchoscopy confirmed squamous cell carcinoma. He underwent thoracoscopic right middle and lower lobectomy. Final pathology showed 2 separate early-stage lung cancers: moderately to poorly differentiated invasive squamous cell carcinoma in the right lower lobe, staged pT2aN0M0 / Stage IB, and moderately to poorly differentiated invasive adenocarcinoma in the right middle lobe, staged pT1aN0M0 / Stage IA. No lymph-node involvement was found. Planned adjuvant chemotherapy was stopped after 3 cycles because he could not tolerate it. Early postoperative complications included pneumothorax, atelectasis, and pleural effusion, which improved with rehabilitation. Eight months later, he developed unusual posture-related symptoms: palpitations, throat tightness, and nasal congestion when upright, relieved when lying down. These peaked around 12 months and resolved by 17 months. He also lost about 20 kg over 2 years despite eating frequently, while tumor recurrence and endocrine causes were excluded. At 17 months, he developed disorientation, impulsive behavior, and agitation. Workup for brain metastases, encephalitis, and vascular disease was negative. Later pneumonia with type II respiratory failure worsened the psychiatric symptoms, and antibiotics plus correction of hypoxia improved both breathing and mental status. More than 3 years after surgery, he remained tumor-free, while only mild psychiatric symptoms persisted after the delayed respiratory complications improved.