Advanced Small Cell Lung Cancer Without Intrathoracic Involvement

Document Type

Conference Proceeding

Publication Date

5-21-2023

Publication Title

Am J Respir Crit Care Med

Abstract

Introduction: Small cell carcinoma is a neuroendocrine tumor that accounts for 20-25% of all neuroendocrine tumors. Extrapulmonary small cell carcinoma (EPSCC) is a rare clinical entity accounting for about 4% of all cases of small cell carcinoma. EPSCC commonly involves the genitourinary and gastrointestinal systems, mostly affecting the prostate, bladder, esophagus, stomach, small intestine, and colon. Case presentation: A 65-year-old gentleman with a past medical history of COPD (Chronic Obstructive Pulmonary Disease) and recently diagnosed type 2 diabetes mellitus presented to the hospital for shortness of breath. He was found to have left upper lobe consolidation on the chest x-ray. CT (Computed Tomography) chest without contrast showed left upper lobe dense consolidation with air bronchogram. There was an incidental low-density mass-like appearance in the liver measuring 7.7 x 5.4 centimeters. Pneumonia was successfully treated with a five-day course of antibiotics. For the concerning liver mass, MRI (Magnetic Resonance Imaging) was done which showed a large and lobulated irregular rim enhancing complex mass originating from the pancreatic head. The patient was referred to Oncology for further evaluation. CT-PET (Positron Emission Tomography) scan (figure) showed confluent, lobulated and FDG (Fluorodeoxyglucose) avid mass in periportal, peripancreatic, and portal caval space. There was no FDG uptake in the lung and the opacities in the region of the previous consolidation showed very minimal FDG uptake. No FDG uptake was seen on mediastinal or hilar lymph nodes. The patient had a CT-guided biopsy for that mass and the pathology showed small-cell carcinoma from lung origin. TTF-1 (Thyroid transcription factor-1) was positive which is expressed specifically in pulmonary or thyroid neoplasms. The patient followed up with Oncology and was started on palliative chemotherapy for small cell lung cancer. Discussion: EPSCC commonly presents as a metastatic tumor with no identifiable lesions in the lung. EPSCC of the liver is a rare entity. Given its rarity, there are no guidelines for diagnostic workup, staging, and/or management strategies of these tumors. Limited-stage tumors are treated similarly to SCLC with a multimodal approach which includes surgery, chemotherapy, and radiation. Most of the tumors given the advanced metastatic stage at presentation are treated palliatively. Recurrence after treatment is common in EPSCC. The overall prognosis is poor with survival from diagnosis to death varying anywhere between 1 week to 2 years.

Volume

207

Issue

1

First Page

A2421

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