Case Report: A Nonsmoking Welder Develops Rare NSCLC

By: Celeste L. Dixon
Posted: Monday, February 24, 2025

Welding is among the occupations that have been causally linked to small cell lung cancer and non–small cell lung cancer (NSCLC), and a recent case report published in the journal Cureus indicates it may have an association with thoracic SMARCA4-deficient undifferentiated tumor (TSDUT) as well. As a welder, the 40-year-old male patient was exposed to volatile oxidized metals—welding fumes are classified as a group 1 carcinogen by the International Agency for Research on Cancer—but he had no substantial smoking history, noted Mufadda Hasan, MD, of Arrowhead Regional Medical Center, Colton, California, and colleagues.

This rare and highly aggressive NSCLC is typically associated with smoking and often affects relatively young men. This is the first described case of a nonsmoker with significant occupational exposure developing TSDUT, to the authors’ knowledge.

This patient’s case demonstrated TSDUT presenting as a Pancoast tumor. Generally, no therapy protocol has been shown to bring this rare NSCLC into remission, but the physicians attempted to treat it with multiple cycles of cisplatin/etoposide and additional atezolizumab maintenance therapy, as well as multiple cycles of palliative radiation therapy. Many complications developed, and 1.5 years after the lesion’s discovery, and 1 year after staging, the patient was placed in hospice care.

“The most common sites of primary malignancy [in TSDUT] are the left upper lobe and the mediastinum,” wrote Dr. Hasan and coauthors. “Often, symptoms from the tumor compressing the pleura and lung parenchyma are reported, and distant metastasis can include the axial skeleton.” In this case, axial skeletal involvement was prominent because of L5 to S1 lumbar stenosis from mass effect. Overall, the “clinical features, immunohistochemistry, and pathology [of TSDUT] are quite unique,” they concluded, and the disease “may present as classical non–small cell lung apex tumors.”

Disclosure: No conflicts of interest information was provided.

Cureus