Northside Hospital Gwinnett Lawrenceville, GA, United States
Raguraj Chandradevan, MD, Mariam Baig, MD, Benjamin Hayes, MD Northside Hospital Gwinnett, Lawrenceville, GA
Introduction: Small cell cancer is an aggressive tumor with poor prognosis. Lung is the predominant site and affects other organs of the body including pancreas. We present a case where initially suspected to be primary lung cancer, however later turned out to be unknown primary site.
Case Description/Methods: 61-year-old white male with a 60-pack year history of smoking presented with pleuritic chest pain, cough and hemoptysis for three weeks. Physical as exam was notable only for scleral icterus. Initial lab results revealed WBC 14.1 K/mcL, HG 12.6 g/dL, platelets of 378 K/mcL T Bili 2.1 mg/dL, ALP 137 IU/L, AST 99 IU/L, ALT 133 IU/L. CT scan of the chest revealed post obstructive pneumonia of the left upper lobe. Bronchoscopy with biopsy revealed small cell cancer. Regarding his elevated liver enzymes, a CT scan of the abdomen showed biliary duct dilatation and a pancreatic head mass. MRI with MRCP images further characterized this lesion as a pancreatic mass and distal common bile duct narrowing and proximal dilatation. Endoscopic ultrasound biopsy of the pancreatic lesion revealed this was also a small cell cancer. It remained unclear whether this was a separate primary or evidence of metastatic disease. Liver enzymes trended down after common bile duct stent placement and patient followed up with oncology. He was started on carboplatin, etoposide and tecentriq.
Discussion: Malignant lesions of the pancreas are not necessarily adenocarcinoma. Pancreatic carcinoma is typically diagnosed at later stages. Symptoms and signs mostly related to obstructive jaundice. Endoscopic ultrasound guided biopsy is the emerging modality for the diagnosis of pancreatic head tumors. Pancreatic cancer metastasis to liver, abdomen as well as lungs, brain and bone. Pancreatic metastasis from a primary malignancy is rare. It can be from kidneys, colorectal, melanoma, breast and lung. In our case presentation, there is no modality or diagnostic investigation to yield the primary site of the malignancy. However, the diagnosis needed tissues biopsies from both sites to prove the histological type of the cancer. This is very important to start chemotherapy as well as to relieve the biliary outflow by ERCP to avoid acute liver failure during chemotherapy.
Figure: In stent dilatation of the Common bile duct during the ERCP procedure.
Raguraj Chandradevan indicated no relevant financial relationships.
Mariam Baig indicated no relevant financial relationships.
Benjamin Hayes indicated no relevant financial relationships.
Raguraj Chandradevan, MD, Mariam Baig, MD, Benjamin Hayes, MD. P2142 - Small Cell Carcinoma of the Pancreas: Dilemma Between Primary or Metastatic Manifestation, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.