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Case Reports in Pulmonology
Volume 2018, Article ID 1718326, 4 pages
Case Report

Coexistent Non–Small Cell Carcinoma and Small Cell Carcinoma in a Patient Presenting with Hyponatremia

1Department of Internal Medicine, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
2Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
3Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
4Department of Radiation Oncology, University of Arizona Cancer Center, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
5Department of Radiology, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA

Correspondence should be addressed to Tanmay S. Panchabhai; gro.htlaehytingid@iahbahcnap.yamnat

Received 1 December 2017; Accepted 18 January 2018; Published 20 February 2018

Academic Editor: Akif Turna

Copyright © 2018 Mitchell D. Ross et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Despite recent advances in screening methods, lung cancer remains the leading cause of cancer-related deaths worldwide. By the time lung cancer becomes symptomatic and patients seek treatment, it is often too advanced for curative measures. Low-dose computed tomography (CT) screening has been shown to reduce mortality in patients at high risk of lung cancer. We present a 66-year-old man with a 50-pack-year smoking history who had a right upper lobe (RUL) pulmonary nodule and left lower lobe (LLL) consolidation on a screening CT. He reported a weight loss of 45 pounds over 3 months, had recently been hospitalized for hyponatremia, and was notably cachectic. A CT of the chest showed a stable LLL mass-like consolidation and a  mm subsolid lesion in the RUL. Navigational bronchoscopy biopsy of the RUL lesion revealed squamous non–small cell lung cancer (NSCLC). Endobronchial ultrasound-guided transbronchial needle aspiration of the LLL lesion revealed small cell lung cancer (SCLC). The final diagnosis was a right-sided Stage I NSCLC (squamous) and a left-sided limited SCLC. The RUL NSCLC was treated with stereotactic radiation; the LLL SCLC was treated with concurrent chemotherapy and radiation. In patients with multiple lung nodules, a diagnosis of synchronous multiple primary lung cancers (MPLCs) is crucial, as inadvertent upstaging of patients with MPLC (to T3 and/or T4 tumors) can lead to erroneous staging, inaccurate prognosis, and improper treatment. Recent advances in the diagnosis of small pulmonary nodules via navigational bronchoscopy and management of these lesions dramatically affect a patient’s overall prognosis.