Muhammad Farhan Ashraf, MD1, Spyridon Zouridis, MD1, Rosa Bui, MD1, Luz Sullivan, MD1, Seth Richter, MD2 1Albany Medical Center, Albany, NY; 2Albany Medical College, Albany, NY
Introduction: Small cell carcinoma(SCC) is a neoplasm that usually arises in the lungs. Only 2.5-4% of small cell carcinoma is extrapulmonary in absence of any lung involvement.1 Extrapulmonary small cell carcinomas are rare while liver and biliary tract small cell carcinomas are extremely rare. Complications include jaundice, hepatomegaly, portal hypertension, and portal venous thrombosis. We present a case of a 68-year-old male patient who presented with abdominal pain and was found to have small cell carcinoma in the liver with abdominal cavity and spine involvement.
Case Description/Methods: A 68-year-old male with a past medical history of prostate adenocarcinoma presented with jaundice, fatigue, and a two-day history of right upper quadrant abdominal pain. The patient reported worsening lower extremity edema and abdominal bloating. On physical exam, he had scleral icterus and palpable tender hepatosplenomegaly. Labs revealed direct bilirubin of 12.6 mg/dl, alkaline phosphatase of 644 IU/L, AST of 222 IU/L, and ALT 117 IU/L. Tumor markers including AFP, CEA and PSA were negative. CT of the abdomen with contrast showed a massively enlarged liver with multiple lesions (largest 5cm) and a mass effect on the IVC. The patient was also found to have portal venous thrombosis, ascites, and extensive intra-abdominal lymphadenopathy. An EUS with periportal lymph node biopsy showed undifferentiated small cell carcinoma. A CT of the thorax was negative for any lung pathology. PET scan and MRI showed multiple lesions in his spine. Given his widespread tissue involvement, he was started on chemotherapy.
Discussion: SCC in the liver without pulmonary involvement is a rare disease that can be a diagnostic challenge as it is quite difficult to distinguish between primary and metastatic lesions. As in our case, pulmonary involvement can be ruled out by chest CT and PET scan. Treatment is mainly the same chemotherapy used for small cell lung cancer. Despite being extremely rare, SCC should be included in the differential diagnosis in patients presenting with hepatomegaly, jaundice and abdominal pain.2 EUS guided biopsy can be an effective diagnostic tool to biopsy hepatic lesions.
1. Remick SC, Ruckdeschel JC. Extrapulmonary and pulmonary small-cell carcinoma: tumor biology, therapy, and outcome. Med Pediatr Oncol. 1992;20(2):89-99.
2. Jo JM, Cho YK, Hyun CL, et al. Small cell carcinoma of the liver and biliary tract without jaundice. World J Gastroenterol. 2013;19(44):8146-8150.
Figure: (a,b)- Liver lesions of CT scan (c) Nests of hypochromic cells on biopsy (d)Chromogranin immunostain highlights neuroendocrine secretory granules.
Disclosures: Muhammad Farhan Ashraf indicated no relevant financial relationships. Spyridon Zouridis indicated no relevant financial relationships. Rosa Bui indicated no relevant financial relationships. Luz Sullivan indicated no relevant financial relationships. Seth Richter indicated no relevant financial relationships.
Muhammad Farhan Ashraf, MD1, Spyridon Zouridis, MD1, Rosa Bui, MD1, Luz Sullivan, MD1, Seth Richter, MD2. P0748 - A Rare Case of Small Cell Carcinoma of the Liver Without Pulmonary Involvement, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.