Lung Cancer: Fellow Case Report Poster - Lung Cancer |

Is It the Chicken or the Egg? A Case of Pancreatic Cancer Diagnosed on Biopsy of the Pulmonary Nodules FREE TO VIEW

Hammad Arshad, MD; Meilin Young, MD; Rajashekar Adurty, MD
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Allegheny General Hospital, Pittsburgh, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):681A. doi:10.1016/j.chest.2016.08.776
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SESSION TITLE: Fellow Case Report Poster - Lung Cancer

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Pancreatic cancer is a rapidly proliferative malignancy where the metastatic sites (lung, liver, or bone) can be involved as an initial presentation.We present a rare case where a patient had neither signs nor symptoms of a brooding metastatic malignancy

CASE PRESENTATION: 74yo CF with PMH COPD , basal cell CA s/p excision, melanoma in situ s/p excision who was found to have bilateral pulmonary nodules with increase in size and number on follow up CT scan. The nodules were biopsied via navigational bronchoscopy and the final pathology reported moderately to poorly differentiated adenocarcinoma. Patient had an extensive workup done to diagnose the occult primary malignancy. Her CA-19-9 was significantly elevated with no abnormality noted in the pancrease on routine imaging. Patient underwent an EGD with EUS showing a hyperechoic mass, measuring 26x19mm in the body of the pancreas that was bisopsied.Final pathology returned as malignant cells consistent with well-differentiated adenocarcinoma. Patient was subsequently diagnosed with metastatic pancreatic adenocarcinoma and is undergoing chemo-threrapy

DISCUSSION: Pancreatic cancer accounts for roughly 2% of all new cancer cases in the United States but ranks as fourth in the leading causes of cancer deaths. It is frequently referred to as the “silent killer” as signs and symptoms such as loss of appetite, weight loss, jaundice, and abdominal pain do not occur until the advanced stages of the disease. Common sites of metastasis are liver, lung, and bone. Rarely, the pulmonary metastasis may mimic lung cancer when the tumor is located in the body or tail of the pancreas as an occult malignancy in the pancreatic duct.Such patients would present with pulmonary complaints such as cough or hemoptysis. This case highlights the importance of considering metastatic pancreatic disease as a differential diagnosis in the evaluation of bilateral pulmonary nodules

CONCLUSIONS: Pancreatic cancer does not have formal routine screening practices. When multiple pulmonary nodules are found on routine imaging, a more extensive work-up, including follow-up imaging, biopsy, and serology should be considered as it may indicate an underlying primary malignancy.

Reference #1: Richwine RT et al.Cough as the presenting symptom of pancreatic adenocarcinoma. J Am Board Fam Pract. 2004 Jan-Feb;17(1):48-53.

Reference #2: Steinke K et al. Pulmonary metastases from pancreatic adenocarcinoma mimicking bronchoalveolar carcinoma. Eur Radiol 2000;10: 1683-4

DISCLOSURE: The following authors have nothing to disclose: Hammad Arshad, Meilin Young, Rajashekar Adurty

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