Lung function testing revealed a restrictive pattern, and the predicted postpneumonectomy FEV1 was 0.96 L (34% predicted) on the basis of a quantitative radionuclide lung perfusion scan. The patient was deemed operable at a clearly elevated risk due to borderline lung function. A right-sided pneumonectomy with partial resection of the chest wall was performed. Macroscopically, the tumor involved all three lung lobes and the lateral chest wall, while the diaphragm, hilum, and hilar lymph nodes were microscopically free of tumor. On histology, the tumor consisted of large cells with abundant cytoplasm, growing in solid sheets and islands with no neuroendocrine morphology such as organoid nesting, palisading, a trabecular pattern, or rosette-like structures. Positive immunostaining for neuron specific enolase, synaptophysin, and chromogranin indicated neuroendocrine differentiation. Epithelial markers were negative. The final oncologic diagnosis was a large cell bronchial carcinoma with neuroendocrine differentiation, T3N0M0, stage IIB, completely resected.