Obstructive jaundice in small cell lung carcinoma.
Small cell lung carcinoma (SCLC) commonly metastasizes to distant organs. However, metastasis to the pancreas is not a common event. Moreover, obstructive jaundice as a first clinical presentation of SCLC is extremely unusual. This case reports a 51-year-old male with SCLC, manifesting with obstructive jaundice as the initial clinical presentation. Endoscopic retrograde cholangiopancreatograghy (ERCP) and abdominal computed tomography (CT) scan showed a mass at the head of the pancreas. The patient underwent pancreatoduodenectomy (Whipple procedure). Histopathology revealed a chromogranin- A-positive poorly-differentiated neuroendocrine carcinoma of the pancreas. No imaging study of the lung was performed before surgery. A few months later, a follow-up CT revealed unilateral lung nodules with ipsilateral hilar nodes. A lung biopsy was done and histopathology reported a TTF- 1-positive, chromogranin A-positive, small cell carcinoma of the lung. On review, the pancreatic tumour was also TTF-1-positive. He was then treated with combination chemotherapy (cisplatin, etoposide). These findings highlight that presentation of a mass at the head of pancreas could be a manifestation of a metastatic tumour from elsewhere such as the lung, and thorough investigations should be performed before metastases can be ruled out.
UKM Medical Center, Faculty of Medicine, Department of Pathology, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia. noraidah@ppukm.ukm.edu.my.
Ali
A
Mokhtar Pour
Noraidah
N
Masir
Mohd Rose
MR
Isa
D002760:Cholangiopancreatography, Endoscopic Retrograde; D003581:Cytodiagnosis; D003951:Diagnostic Errors; D006801:Humans; D007150:Immunohistochemistry; D041781:Jaundice, Obstructive / Q000209:etiology*; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000556:secondary*; D055752:Small Cell Lung Carcinoma / Q000150:complications / Q000556:secondary*; D014057:Tomography, X-Ray Computed