title: An innocent appearing subcutaneous nodule diagnoses a small cell lung cancer in a never-smoker female.
abstract: Lung cancer among never-smokers is recognized as the 7th most common cause of cancer death globally. Adenocarcinoma is the most commonly reported histology. Small cell lung cancer (SCLC) has the strongest association with smoking and is rarely reported in never-smokers. Although lung cancer in never-smokers is more common in women, the overall incidence of SCLC in female never-smokers still remains low. Soft tissue metastases from any cancer are rare with an overall prevalence of 1.8%. Soft tissue metastases from lung primary are uncommon, mostly from adenocarcinoma, and portend a poor prognosis. Cutaneous metastases from SCLC are exceptionally rare with reported incidence of 0.3% to 0.8%. We believe ours is the first reported case of SCLC presenting as subcutaneous nodule, in a never-smoker, otherwise asymptomatic female. The diagnosis of SCLC was made incidentally by the excisional biopsy of the subcutaneous nodule. Subsequent CT chest and PET scan revealed a hypermetabolic right lower lobe spiculated lung mass with adrenal and liver involvement. Platinum and etoposide chemotherapy with prophylactic cranial irradiation was initiated for advanced SCLC, and she required further irinotecan and taxol for subsequent pancreatic and adrenal metastases. With continued deterioration, she died approximately 36 months from diagnosis, while under hospice care.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA.
authors.forename: Nupur
authors.identifier: 0000-0001-8573-3809
authors.initials: N
authors.lastname: Sinha
authors.affiliation: Department of Pathology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA.
authors.forename: Masooma
authors.initials: M
authors.lastname: Niazi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA.
authors.forename: Gilda
authors.initials: G
authors.lastname: Diaz-Fuentes
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Duncalf
references.citation: BMC Med Imaging. 2007 Dec 12;7:8
references.pmid: 18076764
references.citation: Case Rep Med. 2013;2013:136564
references.pmid: 23533424
references.citation: BMJ Case Rep. 2013 May 22;2013:
references.pmid: 23704434
references.citation: Sultan Qaboos Univ Med J. 2013 Aug;13(3):345-58
references.pmid: 23984018
references.citation: World J Oncol. 2010 Oct;1(5):204-207
references.pmid: 29147207
references.citation: J Thorac Dis. 2013 Aug;5(4):538-48
references.pmid: 23991314
references.citation: Eur Rev Med Pharmacol Sci. 2012 Dec;16(14):1908-14
references.pmid: 23242715
references.citation: Trends Mol Med. 2007 Apr;13(4):150-7
references.pmid: 17324626
references.citation: J Clin Oncol. 2006 Oct 1;24(28):4539-44
references.pmid: 17008692
references.citation: Chest. 1994 Nov;106(5):1448-50
references.pmid: 7956399
references.citation: J Am Acad Dermatol. 2009 Mar;60(3):379-87
references.pmid: 19056145
references.citation: Crit Rev Oncol Hematol. 2013 Dec;88(3):494-503
references.pmid: 23921082
references.citation: Nat Rev Cancer. 2007 Oct;7(10):778-90
references.pmid: 17882278