Lung Cancer: Student/Resident Case Report Poster - Lung Cancer I |

The Rare Co-Existence of Primary Small Cell Lung Cancer and Myelodysplastic Syndrome: A Treatment Challenge FREE TO VIEW

Kitty Victoria, MD; Qi Feng, MD; Sami Ali, MD
Author and Funding Information

New York Methodist Hospital, Brooklyn, NY

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

Chest. 2016;150(4_S):740A. doi:10.1016/j.chest.2016.08.835
Text Size: A A A
Published online

SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer I

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: Approximately 1200 cases of Myelodysplatic syndrome (MDS) are diagnosed in the USA each year, 60-90% of them in patients older than 60. Secondary MDS as a delayed complication of cancer treatment is a well known phenomenon, however, the concomitant diagnosis of primary small cell lung cancer (SCLC) and MDS, as in our case, is very rare.

CASE PRESENTATION: A 76-year-old male with a 30-pack-year smoking history was referred to our hospital for weakness of 1-month duration, epistaxis and mucosal bleeding. Initial labs presented: hemoglobin 3.6 mg/dL, eosinophilia, high ferritin and normal B12 and folate. Physical exam was notable for a thin, pale man with a bounding pulse and conjunctival pallor. Bone marrow biopsy revealed a hypercellular marrow, marked myeloid hyperplasia, eosinophilia, increased blasts and erythroid and megakaryocyte hypoplasia. Core bone marrow biopsy FISH resulted in trisomy 8, gain of function mutation in the FGFR1 (fibroblast growth factor receptor 1) and translocation 8p21. A CT scan of the chest revealed a left lung mass with an enlarged hilar lymph node. Endobronchial biopsy confirmed limited stage SCLC. He began treatment for SCLC with cisplatin and etoposide. Chemotherapy induced pancytopenia was complicated by neutropenic fever and the patient was unable to tolerate further chemotherapy for SCLC. He was initiated on Azacitidine for MDS and discharged to rehab. On follow up, his MDS is improving with normal WBC and platelet counts, but persistent anemia requiring transfusions. The SCLC lesion and lymph node increased in size and a recent CT chest demonstrates an additional spiculated lesion.

DISCUSSION: Simultaneous diagnosis of SCLC and MDS is rare and complicates the management. We found only 1 such case report (1). In a study published of 155 patients with MDS, 21 had solid tumors and 11 were simultaneously diagnosed (2). In another case series involving 6 patients with MDS, all were found to later have concomitant solid tumors for which after resection, laboratory abnormalities attributed to MDS resolved (3).

CONCLUSIONS: Our case demonstrates simultaneous diagnoses of SCLC with MDS. Patients with MDS may represent a higher risk population requiring more aggressive screening. The use of chemotherapy can be limited by MDS. Treatment of the primary malignancy, if tolerated, may result in potential cure of both.

Reference #1: Hansen JW, Sjo L, Grønbæk K. Paraneoplastic pancytopenia in a patient with undiagnosed lung cancer. Ugeskr Laeger 2014; 176:V11130675.

Reference #2: Sans-Sabrafen J, Buxo-Costa J, Woessner S, Florensa L, Besses C, Malats N, et al. Myelodysplastic syndromes and malignant solid tumors: analysis of 21 cases. Am J Hematol. 1992;41:1-4.

Reference #3: Aznab M, Kavianymoghadam K. Secondary Myelodysplastic Syndrome May Happen Same as Paraneoplastic Syndrome in a Period of Time and Prior to The Appearance of Malignancy: A case Study of 6 Patients. International Journal of Hematology-Oncology and Stem Cell Research. 2013;7(2):30-34.

DISCLOSURE: The following authors have nothing to disclose: Kitty Victoria, Qi Feng, Sami Ali

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543