What happened, in summary

A 71-year-old man presented with bloody sputum and left-sided chest pain. Imaging showed a mass at the top of the left lung, and biopsy confirmed non-small cell lung cancer. He underwent left upper-lung segmentectomy with lymph-node dissection. The 6 cm tumor did not show clear glandular or squamous features. Pathology instead showed an unusual pattern with both TTF-1 and p40 expression, and PD-L1 expression was 60%. Testing did not identify ALK or ROS1 rearrangements. No lymph-node metastasis was found at surgery. About 4 months later, however, the cancer recurred in the lumbar vertebrae, establishing metastatic disease. He then received chemoradiotherapy. Despite further treatment, the disease remained aggressive, and he died from cancer 9 months after the lung operation.