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Metastasis-Induced Acute Pancreatitis Successfully Treated with Chemotherapy and Radiotherapy in a Patient with Small Cell Lung Cancer.

Okutur K, Bozkurt M, Korkmaz T, Karaaslan E, Guner L, Goksel S, Demir G - Case Rep Oncol Med (2015)

Bottom Line: Although involvement of pancreas is a common finding in small cell lung cancer (SCLC), metastasis-induced acute pancreatitis (MIAP) is very rare.The patient was treated successfully with systemic chemotherapy and radiotherapy delivered to pancreatic field.Aggressive systemic and local treatment can prolong survival, especially in patients with good performance status.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Acibadem University School of Medicine, Buyukdere Caddesi, No. 40, Sariyer, 34453 Istanbul, Turkey.

ABSTRACT
Although involvement of pancreas is a common finding in small cell lung cancer (SCLC), metastasis-induced acute pancreatitis (MIAP) is very rare. A 50-year-old female with SCLC who had limited disease and achieved full response after treatment presented with acute pancreatitis during her follow-up. The radiologic studies revealed a small area causing obliteration of the pancreatic duct without mass in the pancreatic neck, and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed the metastasis of SCLC. The patient was treated successfully with systemic chemotherapy and radiotherapy delivered to pancreatic field. In SCLC, cases of MIAP can be encountered with conventional computed tomography with no mass image, and positron emission tomography and EUS-FNA can be useful for diagnosis of such cases. Aggressive systemic and local treatment can prolong survival, especially in patients with good performance status.

No MeSH data available.


Related in: MedlinePlus

((a) and (b)) A hypermetabolic primary mass distal to the bronchus of the right middle lobe on PET-CT. (c) Infiltration of small cell carcinoma in transbronchial biopsy of the mass (H&E, ×10). (d) Thyroid transcription factor-1 (TTF-1) positive staining of tumor cells (TTF-1, ×10).
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fig1: ((a) and (b)) A hypermetabolic primary mass distal to the bronchus of the right middle lobe on PET-CT. (c) Infiltration of small cell carcinoma in transbronchial biopsy of the mass (H&E, ×10). (d) Thyroid transcription factor-1 (TTF-1) positive staining of tumor cells (TTF-1, ×10).

Mentions: The medical work-up of a 50-year-old female patient who applied for chronic cough revealed a mass in the right lung. She had a 40-year pack smoking history and no history of alcohol abuse. Bronchoscopy showed an occlusive mass in the lateral segment bronchus of the right middle lobe and 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) demonstrated a primary mass distal to the bronchus of the right middle lobe and hypermetabolic enlarged lymph nodes in the right lower and upper paratracheal region and the right supraclavicular region (Figures 1(a) and 1(b)). Bronchoscopic biopsy from the mass confirmed small cell carcinoma (Figures 1(c) and 1(d)). Patient's cranial magnetic resonance imaging (MRI) showed no metastasis, and then she was diagnosed with limited-stage SCLC and started cisplatin-etoposide concurrently with radiotherapy. Treatment was completed without major side effects and a PET-CT was performed after a month, which showed a full metabolic response to the chemoradiotherapy; during follow-up she was provided with prophylactic cranial radiation. The patient was admitted four months after completion of treatment for abdominal pain. The patient reported that she was hospitalized for diagnosis of acute pancreatitis for five days at an outside center two weeks ago; her complaints and amylase level which was initially high were regressed and improved after supportive therapy; however her abdominal pain progressively increased in the last two days. In the physical examination, she had localized pain in the epigastric and periumbilical area; the patient expressed that she felt the pain mostly on the back and lower back. Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was 1 and there was no clinical finding of acute abdomen. The laboratory tests showed a mild leukocytosis and hyperamylasemia (780 U/L) with moderately high C-reactive protein. The patient's history involved no alcohol intake and cholelithiasis, and abdominal computed tomography (CT) demonstrated three metastatic lesions of 0.5–1 cm in diameter in the liver, nodular metastatic thickening in the right adrenal, and diffuse enlargement of the pancreas, and pancreatic ductus became slightly apparent. In addition to metastatic lesions described on abdominal CT, PET-CT showed abnormal focal FDG uptake in the neck and tail of pancreas with diffusely increased FDG uptake (Figure 2(a)). Magnetic resonance cholangiopancreatography (MRCP) revealed a segmental obliteration in the pancreatic duct and dilatation of its distal part (Figure 2(b)); postcontrast MRI sections demonstrated a poorly marginated hypointense area of around 1 cm at obliteration level in the pancreatic duct on the head-corpus junction of the pancreas (Figure 2(c)). Endoscopic ultrasonography (EUS) indicated a very indistinct area with irregular margins in the neck of pancreas and pancreatic duct interruption at this level. The cytopathological examination of EUS-guided fine-needle aspiration (EUS-FNA) from the lesion showed small cell carcinoma cells (Figure 2(d)). The patient was discussed at the tumor board, and a second-line chemotherapy with cisplatin and irinotecan (cisplatin 60 mg/m2 on day 1, irinotecan 60 mg/m2 on days 1, 8, and 15, every 4 weeks) and intensity-modulated radiotherapy (total dose of 30 Gy administered in daily 3-Gy fractions during 10 days) to pancreatic lesion were started concurrently. The patient's abdominal pain was relieved at the end of the first week of systemic chemotherapy and radiotherapy, and it completely disappeared after 3 weeks. The radiological studies performed after completion of second cycle of chemotherapy showed that metastatic lesions were regressed, and involvement of pancreas and dilatation of pancreatic duct disappeared. No pancreatic attacks were observed during follow-up. The patient is still alive at 14 months after her first diagnosis and 8 months after the first pancreatitis attack.


Metastasis-Induced Acute Pancreatitis Successfully Treated with Chemotherapy and Radiotherapy in a Patient with Small Cell Lung Cancer.

Okutur K, Bozkurt M, Korkmaz T, Karaaslan E, Guner L, Goksel S, Demir G - Case Rep Oncol Med (2015)

((a) and (b)) A hypermetabolic primary mass distal to the bronchus of the right middle lobe on PET-CT. (c) Infiltration of small cell carcinoma in transbronchial biopsy of the mass (H&E, ×10). (d) Thyroid transcription factor-1 (TTF-1) positive staining of tumor cells (TTF-1, ×10).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4446459&req=5

fig1: ((a) and (b)) A hypermetabolic primary mass distal to the bronchus of the right middle lobe on PET-CT. (c) Infiltration of small cell carcinoma in transbronchial biopsy of the mass (H&E, ×10). (d) Thyroid transcription factor-1 (TTF-1) positive staining of tumor cells (TTF-1, ×10).
Mentions: The medical work-up of a 50-year-old female patient who applied for chronic cough revealed a mass in the right lung. She had a 40-year pack smoking history and no history of alcohol abuse. Bronchoscopy showed an occlusive mass in the lateral segment bronchus of the right middle lobe and 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) demonstrated a primary mass distal to the bronchus of the right middle lobe and hypermetabolic enlarged lymph nodes in the right lower and upper paratracheal region and the right supraclavicular region (Figures 1(a) and 1(b)). Bronchoscopic biopsy from the mass confirmed small cell carcinoma (Figures 1(c) and 1(d)). Patient's cranial magnetic resonance imaging (MRI) showed no metastasis, and then she was diagnosed with limited-stage SCLC and started cisplatin-etoposide concurrently with radiotherapy. Treatment was completed without major side effects and a PET-CT was performed after a month, which showed a full metabolic response to the chemoradiotherapy; during follow-up she was provided with prophylactic cranial radiation. The patient was admitted four months after completion of treatment for abdominal pain. The patient reported that she was hospitalized for diagnosis of acute pancreatitis for five days at an outside center two weeks ago; her complaints and amylase level which was initially high were regressed and improved after supportive therapy; however her abdominal pain progressively increased in the last two days. In the physical examination, she had localized pain in the epigastric and periumbilical area; the patient expressed that she felt the pain mostly on the back and lower back. Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was 1 and there was no clinical finding of acute abdomen. The laboratory tests showed a mild leukocytosis and hyperamylasemia (780 U/L) with moderately high C-reactive protein. The patient's history involved no alcohol intake and cholelithiasis, and abdominal computed tomography (CT) demonstrated three metastatic lesions of 0.5–1 cm in diameter in the liver, nodular metastatic thickening in the right adrenal, and diffuse enlargement of the pancreas, and pancreatic ductus became slightly apparent. In addition to metastatic lesions described on abdominal CT, PET-CT showed abnormal focal FDG uptake in the neck and tail of pancreas with diffusely increased FDG uptake (Figure 2(a)). Magnetic resonance cholangiopancreatography (MRCP) revealed a segmental obliteration in the pancreatic duct and dilatation of its distal part (Figure 2(b)); postcontrast MRI sections demonstrated a poorly marginated hypointense area of around 1 cm at obliteration level in the pancreatic duct on the head-corpus junction of the pancreas (Figure 2(c)). Endoscopic ultrasonography (EUS) indicated a very indistinct area with irregular margins in the neck of pancreas and pancreatic duct interruption at this level. The cytopathological examination of EUS-guided fine-needle aspiration (EUS-FNA) from the lesion showed small cell carcinoma cells (Figure 2(d)). The patient was discussed at the tumor board, and a second-line chemotherapy with cisplatin and irinotecan (cisplatin 60 mg/m2 on day 1, irinotecan 60 mg/m2 on days 1, 8, and 15, every 4 weeks) and intensity-modulated radiotherapy (total dose of 30 Gy administered in daily 3-Gy fractions during 10 days) to pancreatic lesion were started concurrently. The patient's abdominal pain was relieved at the end of the first week of systemic chemotherapy and radiotherapy, and it completely disappeared after 3 weeks. The radiological studies performed after completion of second cycle of chemotherapy showed that metastatic lesions were regressed, and involvement of pancreas and dilatation of pancreatic duct disappeared. No pancreatic attacks were observed during follow-up. The patient is still alive at 14 months after her first diagnosis and 8 months after the first pancreatitis attack.

Bottom Line: Although involvement of pancreas is a common finding in small cell lung cancer (SCLC), metastasis-induced acute pancreatitis (MIAP) is very rare.The patient was treated successfully with systemic chemotherapy and radiotherapy delivered to pancreatic field.Aggressive systemic and local treatment can prolong survival, especially in patients with good performance status.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Acibadem University School of Medicine, Buyukdere Caddesi, No. 40, Sariyer, 34453 Istanbul, Turkey.

ABSTRACT
Although involvement of pancreas is a common finding in small cell lung cancer (SCLC), metastasis-induced acute pancreatitis (MIAP) is very rare. A 50-year-old female with SCLC who had limited disease and achieved full response after treatment presented with acute pancreatitis during her follow-up. The radiologic studies revealed a small area causing obliteration of the pancreatic duct without mass in the pancreatic neck, and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed the metastasis of SCLC. The patient was treated successfully with systemic chemotherapy and radiotherapy delivered to pancreatic field. In SCLC, cases of MIAP can be encountered with conventional computed tomography with no mass image, and positron emission tomography and EUS-FNA can be useful for diagnosis of such cases. Aggressive systemic and local treatment can prolong survival, especially in patients with good performance status.

No MeSH data available.


Related in: MedlinePlus