What happened, in summary

A 67-year-old woman and former 20-pack-year smoker presented with hypertrophic osteoarthropathy and was diagnosed with Stage III lung adenocarcinoma and bulky mediastinal lymph-node involvement. Initial chemotherapy caused the mediastinal adenopathy to resolve, although the primary lung tumor later began to enlarge. She then received second-line anti-PD-L1 immunotherapy for 5 months. Her best response during immunotherapy was stable disease, and she had no pulmonary toxicity. Biopsies from several mediastinal lymph-node stations found no viable metastatic cancer. PET imaging showed that the right lower-lobe mass was enlarging but the disease appeared confined to that primary site. She therefore underwent surgical exploration, right lower lobectomy and mediastinal lymph-node dissection. Surgical pathology showed residual lung tumor with no viable cancer in the sampled mediastinal nodes. Her postoperative recovery was uncomplicated. At postoperative follow-up, she remained alive, disease free and off treatment after complete resection.