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

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.

Metastatic Small Cell Carcinoma Presenting as Acute Pancreatitis

“…Our patient presented with abdominal pain, and the etiology of his MIAP was likely an extraparenchymal compression from mediastinal lymphadenopathy noted on chest CTA. While pancreatic metastasis often indicates advanced SCLC, MIAP rarely can be the initial presenting symptom of SCLC, as in this case [5]. EUS-FNA is sometimes employed for accurate evaluation and diagnosis of metastatic pancreatic lesions, and the diagnostic accuracy from FNA of metastatic pancreatic lesions is 89% to 92%; biopsy from FNA confirmed our patient's diagnosis of SCLC [1,5,13].…”

“…While pancreatic metastasis often indicates advanced SCLC, MIAP rarely can be the initial presenting symptom of SCLC, as in this case [5]. EUS-FNA is sometimes employed for accurate evaluation and diagnosis of metastatic pancreatic lesions, and the diagnostic accuracy from FNA of metastatic pancreatic lesions is 89% to 92%; biopsy from FNA confirmed our patient's diagnosis of SCLC [1,5,13]. Endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct stenting has a role in improving both clinical symptoms and serum pancreatic enzyme levels for compressing metastases [1,5,13].…”

“…Retrospective studies of patients with lung carcinoma who developed MIAP note an incidence as low as 0.12%; however, the incidence of MIAP in patients with SCLC ranges between 0.4% and 7.5% of all SCLC cases in other retrospective analyses [3,5,9,11,12]. The most common symptoms of MIAP secondary to SCLC are abdominal pain and jaundice, likely secondary to pancreatic duct obstruction; however, 53% to 80% of patients with pancreatic metastases are asymptomatic at the time of incidental diagnosis by abdominal CT [5,6]. Our patient presented with abdominal pain, and the etiology of his MIAP was likely an extraparenchymal compression from mediastinal lymphadenopathy noted on chest CTA.…”

“…However, chemotherapy use and an Eastern Cooperative Oncology Group (ECOG) score < 2 had a clinically and statistically significant positive impact on survival time when compared to no chemotherapy and an ECOG > 2, respectively [14]. In SCLC patients, the median survival is approximately four to six months with chemotherapy, and as soon as two weeks from time of diagnosis with no treatment [5,14]. At the time of diagnosis, this patient had an ECOG score of 0 and was referred to oncology for chemotherapy, hopefully, to improve his overall survival.…”

“…SCLC is the most common lung malignancy to invade pancreatic tissue, and postmortem autopsies of SCLC patients show metastases to the pancreas in up to 40% of cases [ 1 - 5 ]. Metastatic SCLC presents in three significant forms in the pancreas: as a well-circumcised lesion (50%-73%), generalized pancreatic enlargement (15%-44%), and as multiple small nodules (5%-10%) [ 5 ]. The pancreatic head and pancreatic body are the two most common sites of SCLC metastasis [ 6 ].…”