Primary small cell carcinoma of the pancreas is a rare malignancy with a very poor prognosis. There have been fewer than 50 cases reported with the majority of patients presenting with abdominal symptoms. We report a case of a patient with a psychiatric history who presented with lower extremity swelling. Further testing revealed metastatic small cell carcinoma of the pancreas, and she died within 2 weeks of diagnosis. Our case highlights the need for better recognition of this malignancy to hasten diagnosis and treatment.