SESSION TITLE: Challenges in Lung TumorsSESSION TYPE: Rapid Fire Case ReportsPRESENTED ON: 10/18/2022 10:15 am - 11:10 amINTRODUCTION: Non-small cell lung cancer (NSCLC) is very uncommon in those under 40 years old (1). NSCLC can often present as a central airway obstruction (CAO) or tracheal and/or bronchial stenosis. We present a highly complex case of pregnancy-associated cancer of a 31 year old female G3GP2 that was 29 weeks pregnant that presented with distal tracheal stenosis, right mainstem (RMS) obstruction and left mainstem (LMS) stenosis and diagnosed with mNSCLC.CASE PRESENTATION: 31 year old female G3P2, 29 weeks pregnant, non-smoker with no past medical history presents with increased shortness of breath and acute hypoxic respiratory failure. Over six weeks she experienced worsening dyspnea, cough, scant hemoptysis and fatigue. CT chest showed enlarged mediastinal mass with obliteration of the RMS bronchus, 50% stenosis of LMS bronchus and >90% tracheal stenosis. To avoid worsening hypoxia and potential fetal harm the patient was taken to the operating room and cannulated for extracorporeal membrane oxygenation (ECMO) followed by intubation. Initial bronchoscopic evaluation showed complete obstruction of the RMS, 50% stenosis of LMS and distal trachea narrowed 20%. Rigid bronchoscope used to obtain endobronchial biopsies. Argon plasma coagulation was used to destroy the tumor in the right mainstem and a 10x40 AERO covered stent was placed. The left mainstem was dilated to 10mm with CRE balloon. Pathology confirmed adenocarcinoma positive for high PD-L1 expression. Staging showed patient had metastatic lesions to the spine and brain. She underwent cesarian delivery at 31 weeks and subsequently started tyrosine kinase inhibitor antineoplastic agent.DISCUSSION: Pregnancy-associated cancer is rare and complex diagnosis which involves a significant multi-disciplinary approach. Pregnancy-associated cancer is defined as a cancer diagnosis from the first day of childbearing to one year post-partum and usually involves a diagnosis of breast, cervical cancer or lymphoma (3). In this case we present a case of a non-smoker presenting with metastatic adenocarcinoma of the lung. Due to maternal hypoxia attempts were made to improve maternal oxygenation and prolong fetal development. Ultimately, due to continued hypoxia throughout her pregnancy the decision was made to undergo cesarian section at 31 weeks. In cases not requiring intervention chemotherapy is used for treatment with close fetal monitoring (3). This case provides an example that given rarity of diagnosis and the fact there needs to be a multi-disciplinary approach.CONCLUSIONS: Pregnancy-associated cancer requires an in-depth multidisciplinary approach as there is standardized treatment other than prolonging maternal life and allowing for fetal development. However, given many of these cases present in advanced states such as this case other interventions may need to be considered and performed.Reference #1: Pan, X., Lv, T., Zhang, F. et al. Frequent genomic alterations and better prognosis among young patients with non-small-cell lung cancer aged 40 years or younger. Clin Transl Oncol 20, 1168–1174 (2018). https://doi.org/10.1007/s12094-018-1838-zReference #2: Daneshvar, C., Falconer, W., Ahmed, M., Sibly, A., Hindle, M., Nicholson, T., Aldik, G., Talisinghe, L., Marchbank, A., & Breen, D. (2019). Prevalence and outcome of central airway obstruction in patients with lung cancer. Lung Cancer. https://doi.org/http://dx.doi.org/10.1136/bmjresp-2019-000429Reference #3: Flora Zagouri, Constantine Dimitrakakis, Spyridon Marinopoulos, Alexandra Tsigginou, Meletios-Athanassios Dimopoulos Cancer in pregnancy: disentangling treatment modalities, ESMO Open,Volume 1, Issue 3,2016,e000016, ISSN 2059-7029, https://doi.org/10.1136/esmoopen-2015-000016.DISCLOSURES: No relevant relationships by Jason BallengeeNo relevant relationships by Ashish MaskeyNo relevant relationships by Matthew McCoyNo relevant relationships by Amber McCoyNo relevant relationships by Scott Yee SESSION TITLE: Challenges in Lung Tumors SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Non-small cell lung cancer (NSCLC) is very uncommon in those under 40 years old (1). NSCLC can often present as a central airway obstruction (CAO) or tracheal and/or bronchial stenosis. We present a highly complex case of pregnancy-associated cancer of a 31 year old female G3GP2 that was 29 weeks pregnant that presented with distal tracheal stenosis, right mainstem (RMS) obstruction and left mainstem (LMS) stenosis and diagnosed with mNSCLC. CASE PRESENTATION: 31 year old female G3P2, 29 weeks pregnant, non-smoker with no past medical history presents with increased shortness of breath and acute hypoxic respiratory failure. Over six weeks she experienced worsening dyspnea, cough, scant hemoptysis and fatigue. CT chest showed enlarged mediastinal mass with obliteration of the RMS bronchus, 50% stenosis of LMS bronchus and >90% tracheal stenosis. To avoid worsening hypoxia and potential fetal harm the patient was taken to the operating room and cannulated for extracorporeal membrane oxygenation (ECMO) followed by intubation. Initial bronchoscopic evaluation showed complete obstruction of the RMS, 50% stenosis of LMS and distal trachea narrowed 20%. Rigid bronchoscope used to obtain endobronchial biopsies. Argon plasma coagulation was used to destroy the tumor in the right mainstem and a 10x40 AERO covered stent was placed. The left mainstem was dilated to 10mm with CRE balloon. Pathology confirmed adenocarcinoma positive for high PD-L1 expression. Staging showed patient had metastatic lesions to the spine and brain. She underwent cesarian delivery at 31 weeks and subsequently started tyrosine kinase inhibitor antineoplastic agent. DISCUSSION: Pregnancy-associated cancer is rare and complex diagnosis which involves a significant multi-disciplinary approach. Pregnancy-associated cancer is defined as a cancer diagnosis from the first day of childbearing to one year post-partum and usually involves a diagnosis of breast, cervical cancer or lymphoma (3). In this case we present a case of a non-smoker presenting with metastatic adenocarcinoma of the lung. Due to maternal hypoxia attempts were made to improve maternal oxygenation and prolong fetal development. Ultimately, due to continued hypoxia throughout her pregnancy the decision was made to undergo cesarian section at 31 weeks. In cases not requiring intervention chemotherapy is used for treatment with close fetal monitoring (3). This case provides an example that given rarity of diagnosis and the fact there needs to be a multi-disciplinary approach. CONCLUSIONS: Pregnancy-associated cancer requires an in-depth multidisciplinary approach as there is standardized treatment other than prolonging maternal life and allowing for fetal development. However, given many of these cases present in advanced states such as this case other interventions may need to be considered and performed. Reference #1: Pan, X., Lv, T., Zhang, F. et al. Frequent genomic alterations and better prognosis among young patients with non-small-cell lung cancer aged 40 years or younger. Clin Transl Oncol 20, 1168–1174 (2018). https://doi.org/10.1007/s12094-018-1838-z Reference #2: Daneshvar, C., Falconer, W., Ahmed, M., Sibly, A., Hindle, M., Nicholson, T., Aldik, G., Talisinghe, L., Marchbank, A., & Breen, D. (2019). Prevalence and outcome of central airway obstruction in patients with lung cancer. Lung Cancer. https://doi.org/http://dx.doi.org/10.1136/bmjresp-2019-000429 Reference #3: Flora Zagouri, Constantine Dimitrakakis, Spyridon Marinopoulos, Alexandra Tsigginou, Meletios-Athanassios Dimopoulos Cancer in pregnancy: disentangling treatment modalities, ESMO Open,Volume 1, Issue 3,2016,e000016, ISSN 2059-7029, https://doi.org/10.1136/esmoopen-2015-000016. DISCLOSURES: No relevant relationships by Jason Ballengee No relevant relationships by Ashish Maskey No relevant relationships by Matthew McCoy No relevant relationships by Amber McCoy No relevant relationships by Scott Yee