Case history

A 53 year old woman presented in October 1987 with a several week history of dyspnoea and left sided pleuritic chest pain. A chest x ray showed a left sided pleural effusion, cytology of which showed reactive mesothelial cells. The effusion recurred in January 1990, prompting bronchoscopic and thoracoscopic examinations. The broncoscopy revealed no abnormalities but the thoracoscopy showed thickening of the pleura at the left lung base. After a pleural biopsy, a diagnosis of metastatic poorly differentiated non small cell carcinoma was made. The patient received six cycles of cisplatin/carboplatin and responded well. However, in 1994, computed tomography revealed a small tumour in the …