Extensive Invasion of the Left Atrium by Lung Cancer

A 52-year-old man complained of cough and hemoptysis for 1 month. Chest computed tomography scan revealed a 9 cm × 7 cm right lung mass invading the right inferior pulmonary vein and left atrium extensively, and the inferior pulmonary vein was completely occluded. Transsternal echocardiogram confirmed that the lesion invaded the apex of left atrium adjacent to the right pulmonary inferior vein. Positron emission tomography scan showed no other metastatic disease. Bronchoscopy with endobronchial biopsy demonstrated a low-grade squamous cell carcinoma. After 2 cycles of induction chemotherapy, he underwent resection with cardiopulmonary bypass. Postoperative pathology was sarcoma mixed with squamous carcinoma (10%), without lymph node metastasis. Both the bronchial and atrial margins were negative, pathology stage T4N0M0, IIIA. He recovered without postoperative complications, and went back to work 20 days after surgery. He received four cycles of subsequent chemotherapy, but a solitary brain metastasis was discovered 7 months later, and he died 9 months after surgery.