A 76-year-old male patient with a history of smoking and COPD was referred for a lung mass in 2018. His CT scan revealed a 1.4 cm x 1.3 cm mass in the right upper lobe and a mass-like consolidation in the right lower lobe. A biopsy of the right upper lobe mass of his lung showed adenocarcinoma, and he was diagnosed with stage cT1bN0M0 lung cancer. The patient refused surgery and was treated with stereotactic radiosurgery on the right upper lobe mass. However, a follow-up CT scan in 2020 showed that the right lower lobe mass had
increased, and the biopsy revealed squamous cell carcinoma (Figure 1 and 2). The patient underwent separate stereotactic radiosurgery for squamous cell carcinoma and a new peripheral nodule in the right lower lobe. Five months later, a new nodule emerged in the left lower lobe, and the biopsy revealed small-cell lung carcinoma. The patient was treated with
chemotherapy and concurrent thoracic radiation.

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