Lung Cancer |

Non-small Cell Lung Cancer Masquerading as Early Onset Dementia: A Known Entity With an Unknown Presentation FREE TO VIEW

Ameer Rasheed, MD; Viswanath Vasudevan, MD; Qammar Abbas, MD
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The Brooklyn Hospital Center, Brooklyn, NY

Chest. 2014;146(4_MeetingAbstracts):621A. doi:10.1378/chest.1994330
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SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Non-small cell lung cancer (NSCLC) is the leading cause of mortality. It usually presents as lung mass with early metastasis. Central nervous system metastases presents as single ring enhanced lesion, causing seizures, focal deficits and headaches. We report a unique case of NSCLC without any evident lung mass presenting as gradual memory decline in otherwise healthy young female.

CASE PRESENTATION: A 61-year-old woman otherwise healthy, with 30-pack-year smoking history, presented with the only symptom of progressive memory loss over last few weeks. CBC, CMP, coagulation profile, ESR, and CRP were normal. CT head showed 2cm round lesion in right occipital region. MRI brain showed multiple cerebral and cerebellar ring-enhancing lesions. T-SPOT TB, toxoplasma antibodies and HIV testing were negative. CT of chest showed scattered areas of moderate emphysema but no definite mass or nodule. CT of abdomen/pelvis was unremarkable. Malignancy was though least likely due to absence of a mass lesion on contrast enhanced imaging, atypical symptoms and presence of multiple ring enhancing lesions bilaterally. Right posterior temporal craniotomy was performed and biopsy revealed poorly differentiated non-small cell carcinoma with lung primary. It was negative for ALK or EGFR mutation. She received brain radiation therapy.

DISCUSSION: There are rare case of memory loss associated with Limbic Encephalitis, a paraneuplastic syndrome associated with adenocarcinoma. Diagnosis of limbic encephalitis is made on an MRI showing temporal lobe enhancement and by presence of anti-hu antibodies. Our patient did not have limbic encephalitis and her memory loss was likely secondary to temporal lobe dysfuntion. Treatment includes immunotherapy (if tumor is EGFR or ALK positive) and a combination of surgery and chemotherapy for primary lung mass. ALK positive NSCL commonly goes to CNS and responds to immunotherapy. The treatment guidelines are lacking for an EGFR and ALK negative NSCLC without any evident lung mass.

CONCLUSIONS: NSCLS may have metastasis to CNS in early disease without evident lung mass and may present as a gradual decline in memory mimicking early onset of dementia in otherwise an asymptomatic patient. NCSCL should be kept in mind as part of the differential diagnosis in these cases particularly in presence of a strong smoking history.

Reference #1: Said S1, Cooper CJ, Reyna E, Alkhateeb H, Diaz J, Nahleh Z. Paraneoplastic limbic encephalitis, an uncommon presentation of a common cancer. Am J Case Rep. 2013 Oct 1;14:391-4.

DISCLOSURE: The following authors have nothing to disclose: Ameer Rasheed, Viswanath Vasudevan, Qammar Abbas

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