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

Small Cell Lung Cancer Presenting as Painful Obstructive Jaundice FREE TO VIEW

Joanna Scoon, MD; Yi Chun Yeh, MD; Ala Eddin Sagar, MD; Robert Lodato, MD
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University of Texas at Houston, McGovern Medical School, Houston, TX

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

Chest. 2016;150(4_S):763A. doi:10.1016/j.chest.2016.08.858
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SESSION TITLE: Student/Resident Case Report Poster - Lung Cancer II

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: Small cell lung cancer (SCLC) is an aggressive tumor that metastasizes to bone, brain, adrenal gland, or liver. Lung cancer rarely metastasizes to the pancreas [1-2]. We present an unusual case of painful obstructive jaundice as the initial manifestation of SCLC.

CASE PRESENTATION: 75-year-old male with history of alcohol abuse, cigarette smoking and COPD, was admitted for painful jaundice. He endorsed significant weight loss, epigastric pain and chronic cough. Vital signs were within normal limits. Physical examination showed cachexia, jaundice, diffuse bruising, telangiectasias and epigastric tenderness without rebound or guarding. Laboratory data was consistent with obstructive jaundice with liver dysfunction: total bilirubin 9.2 mg/dL, direct bilirubin 6.8 mg/dL, albumin 2.5 g/dl, alanine aminotransferase 189 U/L, aspartate aminotransferase 148 U/L, alkaline phosphatase 531 U/L and international normalized ratio 1.26. Chest radiograph showed a new right hilar opacity. Chest computed tomography (CT) showed a large right hilar mass encasing the mid superior vena cava, right main pulmonary artery and right superior pulmonary vein. The abdominal CT showed numerous pancreatic masses with the largest in the pancreatic head with contiguous invasion into the main portal vein leading to tumor thrombus. The abdominal CT also showed bilateral perinephric nodules, peritoneal nodules, and metastatic bony lesions. Magnetic resonance cholangiopancreatography showed a 3.2 cm mass at head of pancreas obstructing the common bile duct causing intra- and extrahepatic ductal dilation. Endoscopic retrograde cholangiopancreatography showed pancreatic stricture, pancreatic duct dilatation and a pancreatic head mass. A biliary stent was placed. Biopsies of the pancreatic mass and the lung mass showed high-grade neuroendocrine carcinoma, small cell type. He received palliative chemotherapy with carboplatin and etoposide.

DISCUSSION: This patient represents an unusual case of SCLC presenting as painful obstructive jaundice. Metastasis to the pancreas is relatively uncommon, accounting for only 2-5% of all pancreatic malignant tumors in clinical series [1]. Although SCLC is the most common histology found in lung cancer metastasis to the pancreas, it rarely presents with acute pancreatitis or jaundice secondary to extrahepatic biliary obstruction [2].

CONCLUSIONS: This case emphasizes that painful obstructive jaundice with a mass at the head of the pancreas may represent a metastatic neoplasm, including SCLC.

Reference #1: 1. Crippa, S., Angelini, C., Mussi, C., et al. Surgical Treatment of Metastatic Tumors to the Pancreas: A Single Center Experience and Review of the Literature. World Journal of Surgery. 2006; 30(8):1536-1542.

Reference #2: 2. Maeno, T., Satoh, H., Ishikawa, H., et al. Patterns of pancreatic metastasis from lung cancer. Anticancer Research.1998; 18(4B):2881-2884.

DISCLOSURE: The following authors have nothing to disclose: Joanna Scoon, Yi Chun Yeh, Ala Eddin Sagar, Robert Lodato

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