CASE PRESENTATION: A 66-year-old Chinese non-smoking woman presented with progressive chest pain for 4 months. She had a 15-pound weight loss and was referred for inpatient hypercalcemia evaluation. Her chest X-Ray and subsequent CT showed extensive circumferential pleural thickening with small pockets of loculated pleural effusion and ipsilateral mediastinal and hilar lymph nodes; there was no lung mass identified. Incidentally noted were lytic lesions in her spine and left trochanter. Given the cluster of radiographic findings, a closed pleural biopsy using an Abrams’ needle was performed. Molecular interrogation demonstrated cells to be malignant and positive for adenocarcinoma markers (Napsin A+, TTF-1+); mesothelial and squamous markers were negative. This confirmed the diagnosis of primary lung adenocarcinoma. Genetic analysis later demonstrated a mutation in EGFR. PFT showed restriction with reduced FVC (1.53L, 49% predicted), FEV1 (1.19L, 50% predicted) and TLC (3.25L, 64% predicted). The DLCO was 48% predicted. The patient was started on erlotinib as definitive treatment with palliative radiotherapy to her spine and leg.