Solitary brain metastasis of an occult and stable small-cell lung cancer in a schizophrenic patient: a 3-year control.
Small-cell lung cancer is a highly aggressive carcinoma, with poorer prognosis in patients with brain metastases. We present the case of a 49-year-old woman diagnosed with a cerebellar tumour which, following surgery, was revealed to be a metastatic small-cell lung carcinoma. Subsequent CT and PET scanning showed a small, isolated 8 mm nodule in the upper lobe of the right lung. The patient was suffering from schizophrenia and has been treated with clozapine for 17 years. Because of the unusual presentation, there was no therapy given for the primary tumour at the time, and systemic therapy or surgery was discussed. However, 18 months later, the nodule was slightly larger (14 mm), and surgery was performed. On pathology examination, the tumour was presented as a typical small-cell carcinoma. Standard chest irradiation with systemic chemotherapy was given. At the time of writing, 39 months after diagnosis of metastatic small-cell carcinoma, the patient is disease free. However, this case is unusual in that a long-term observation of a small stable primary tumour in the lung took place without any therapy being given. This case strongly supports the thesis that small-cell lung cancer may comprise a heterogeneous group of tumours with different biological properties. The proapoptotic effect of clozapine may be also taken into account.
Jesien-Lewandowicz
Emilia
E
Department of Radiation Oncology, Medical University of Lodz, Paderewskiego 4, 93-509 Lodz, Poland. emilia.jesien-lewandowicz@umed.lodz.pl
Spych
Michal
M
Fijuth
Jacek
J
Kordek
Radzislaw
R
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000556:secondary / Q000628:therapy; D016190:Carboplatin / Q000008:administration & dosage; D003024:Clozapine / Q000627:therapeutic use; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D011878:Radiotherapy; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D055752:Small Cell Lung Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000556:secondary / Q000628:therapy; D014057:Tomography, X-Ray Computed
D014150:Antipsychotic Agents; D005047:Etoposide; D016190:Carboplatin; D003024:Clozapine