Stage IV pleomorphic lung cancer complicated by esophageal invasion and severe infection

What happened, in summary

A 71-year-old man with a long smoking history developed recurrent vomiting and was found to have a mass in the chest. A lymph-node biopsy diagnosed lung cancer, with testing showing a BRAF V600E mutation and high PD-L1 expression.

Further imaging showed a large cancer centered in the left lung hilum with extensive invasion into the mediastinum. The disease was Stage IV, with spread involving the pleura, peritoneum, bones, and several lymph-node areas. Anticancer treatment had not yet started.

Before planned treatment could begin, he was admitted urgently with fever, shortness of breath, and severe infection. The cancer had invaded the esophagus, creating a connection into the mediastinum and contributing to repeated aspiration and pneumonia. Antibiotics and supportive treatment temporarily improved some of the infection findings, but his breathing problems worsened.

He died 21 days after admission from respiratory failure. Autopsy confirmed pleomorphic carcinoma arising from the left lung, with extensive local invasion and widespread metastatic disease.