Pancreatic Metastasis and Obstructive Jaundice in Small Cell Lung Carcinoma
A 65-yr-old woman was presented with jaundice and weight loss. Hypertension was the only significant past medical history. She also complained about general weakness and malaise. A physical examination revealed a jaundiced woman with good performance. Examination of the cardiorespiratory system was unremarkable. The abdomen was soft, and no evidence of organomegaly. The initial laboratory workup revealed a normal complete blood count and chemistry panel. The hepatic panel revealed alkaline phosphatase levels of 339 U/L (Normal range: 40-120 U/L), AST of 512 U/L (Normal range: 10-36 U/L), ALT of 441U/L (Normal range: 7-38 U/L), total bilirubin of 9.2 mg/dL (Normal range: 0.2-1.3 mg/dL) and a direct bilirubin of 4.72 mg/dL (Normal range: 0.0-0.35 mg/dL). A chest radiograph showed a mass in the left lower lung field, later confirmed by a tomographic chest scan. Subsequently, a magnetic resonance cholangio-pancreatography of the abdomen was done, which revealed a mass in the head and tail of the pancreas ().\nThe patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS), which conformed the presence of a mass in the head of the pancreas, causing an extrahepatic bile duct obstruction. During ERCP, the guidewire couldn't pass over the obstructive lesion, therefore the bile duct obstruction was relieved with a stent placement (). The patient underwent an aspiration cytologic exam of the pancreas, which revealed many clusters of small tumor cells. The patient underwent a bronchoscopic biopsy of the left lower lobe mass which revealed a small cell carcinoma ().\nExtensive staging workup did not reveal any other metastatic site. The patient was treated with combination chemotherapy (irinotecan, cisplatin) and a complete remission was achieved in six months (). There was no recurrence of the disease during follow-up for 11 months, and the patient is doing well.