Case Report A Rare Case of Non-Small Cell Lung Carcinoma in an 18-Year-Old Female Balakrishnan Menon 1 , Ritu Kulshrestha 2 , Bhumika Aggarwal 1 , Saurabh Sharma 1 and Pankaj Jain 2 Departments of Respiratory Allergy and Applied Immunology 1 and Pathology 2 , Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India ABSTRACT We report a case of an 18-year-old non-smoker female with no family history of malignancy, and no other risk factors like occupational or environmental exposure, past history of tuberculosis or chronic obstructive bronchitis, who presented with a large mass lesion on chest radiograph and computed tomographic scan. Histopathologically, it was proven to be non-small cell lung carcinoma (NSCLC)-subtype bronchogenic adenocarcinoma. This case warrants further analysis regarding the changing trend of higher incidence of adenocarcinoma in young patients, and that female patients appear to develop lung cancer at an earlier age. [Indian J Chest Dis Allied Sci 2007; 49: 103-105] Key words: Carcinoma; Non-small cell lung, Female. [Received: November 17, 2005; accepted after revision: May 15, 2006] Correspondence and reprint requests: Dr Balakrishnan Menon, Reader, Department of Respiratory Allergy and Applied Immunology, Vallabhbhai Patel Chest Institute, University of Delhi, P.O. Box 2101, Delhi-110 007, India; Tele.: 91-011-27667441, Extn 152; Telefax: 91-011-27667420; E-mail: balakmenon@yahoo.co.in. INTRODUCTION Lung cancer is a leading cause of cancer deaths in developed countries and is also rising at alarming rates in developing countries. This is the single most devastating cause of cancer-related deaths with approximately 1.5 million cases worldwide. 1 Lung cancer is responsible for about one million deaths per year at present and it will rise to three millions per year by the year 2010. 1 Incidence and mortality from lung cancer in females is rising while it is declining in the males. 2 Currently, lung cancer accounts for 20% of all cancer related deaths in females. 3 Of all newly diagnosed cases of lung cancer approximately 80% are non-small cell lung carcinoma (NSCLC). 4 Young patients are very likely to be symptomatic, have adenocarcinoma, and present with advanced disease. 5 There is a changing trend of higher incidence of adenocarcinoma in young patients. Amongst these, female patients appear to develop lung cancer at an earlier age. 7 In addition to smoking, occupational exposure to carcinogens, indoor air pollution, dietary factors and a family history of cancer have recently been implicated in causation of lung cancer. 1 We report a case of an 18-year-old non-smoker female patient with NSCLC, with a mass lesion involving the carina with atypical mitotic figures and gland formation in the absence of any known aetiological risk factors. CASE REPORT An 18-year-old married female presented with complaints of continuous, non-radiating pain in the chest, back and right hypochondrium, dull aching in character, increasing with coughing and deep inspiration, and a progressively increasing swelling in right side of the chest and right hypochondrium for the past six months. History of anorexia and undocu- mented weight loss for past six months were present. She was a non-smoker and had no significant past medical or family history. Her menstrual and obstetric history was normal. There was no history of occupational or environmental exposure. On examination, the patient was of thin built, with pallor on general physical examination. Systemic examination revealed shift of trachea to left with a swelling over the right side of the chest and the right hypochondrium which was tender on palpation. On auscultation, normal vesicular breath sounds were heard on the left side of the chest whereas the breath sounds were absent on the right side. Investigations revealed haemoglobin 8.8 g/dL with a normal differential and total leucocyte count. Sputum was negative for acid-fast bacilli. Chest radiograph revealed an opaque hemithorax on the right side with left shifting of trachea and mediastinum. Bone and soft tissues were unremarkable (Figure 1). Ultrasonography (USG) of the chest revealed a large heterogeneous