Her initial workup revealed enlarged mediastinal nodes, bilateral ground glass interstitial opacities with areas of septal thickening, an incidental 4-cm left lower lobe nodular mass, multiple hypermetabolic lesions in the liver (the largest was 2.8 cm with a standard uptake value of 43), and osseous metastatic disease.
Ultrasound-guided biopsy showed poorly differentiated metastatic lung adenocarcinoma (stage 4) with 5% tumor cells expressing PD-L1 and negative for EGFR/ALK gene alterations.
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