A case of small-cell lung cancer with recurrence of solitary pancreatic metastasis detected by FDG-PET/CT
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CASE REPORT
A case of small-cell lung cancer with recurrence of solitary pancreatic metastasis detected by FDG-PET/CT Kei Nakashima • Masafumi Misawa • Makoto Narita • Haruki Kobayashi Ryo Matsunuma • Nobuhiro Asai • Naoko Katsurada • Hideki Makino • Yoshihiro Ohkuni • Norihiro Kaneko • Masahiro Aoshima
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Received: 2 February 2012 / Accepted: 9 November 2012 / Published online: 20 December 2012 Ó The Japan Society of Clinical Oncology 2012
Abstract A 63-year-old man visited an outpatient clinic complaining of 3-month continuous cough and left chest pain. He was diagnosed as having small-cell lung cancer with limited disease in the left lung by the bronchoscopy, enhanced CT, FDG-PET/CT and enhanced brain MRI. He received a regime of chemotherapy consisting of six cycles of carboplatin and etoposide with concurrent radiation therapy of 60 Gy. He was evaluated as showing complete response, and prophylactic cranial irradiation was performed. Nine months later, while routine enhanced CT could not detect obvious relapse in the pancreas, abnormal uptake at the pancreas head was detected in fluorine-18 fluorodeoxyglucose positron emission tomography (F-18FDG-PET)/computed tomography (CT). Transgastric endoscopic ultrasound-guided fine-needle aspiration biopsy of the pancreas head was carried out, which showed smallcell carcinoma. Immunohistochemical staining was positive for thyroid transcription factor-1, synaptophysin, chromogranin A and notably of AE1/AE3. Thus, the patient was diagnosed as having a recurrence of small-cell lung cancer with pancreatic metastasis. He received another four cycles of carboplatin and etoposide for sensitive relapse. The tumor was diminished and showed partial response. We have to be aware of the possibility of solitary metastasis to the pancreas from lung cancer. FDG-
PET/CT may be useful for early detection of pancreatic metastasis, leading to the early diagnosis and precise therapy.
K. Nakashima (&) M. Misawa M. Narita H. Kobayashi R. Matsunuma N. Asai N. Katsurada H. Makino Y. Ohkuni N. Kaneko M. Aoshima Department of Pulmonology, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan e-mail: [email protected]
Case report
M. Narita Department of Clinicopathology, Kameda Medical Center, Kamogawa, Chiba, Japan
Keywords Small-cell lung cancer Pancreatic metastasis FDG-PET/CT
Introduction Solitary metastasis to the pancreas is rare in small-cell lung cancer. It is important to recognize pancreatic metastasis because in some cases it has caused serious complications such as acute pancreatitis or obstructive jaundice [1, 2]. Recently, fluorine-18 fluorodeoxyglucose positron emission tomography (F-18-FDG-PET)/computed tomography (CT) systems, which enable PET and CT data acquisition in the same setting without changing the patient’s positioning, have been introduced in clinical practice for the purpose of the detection of metastasis in malignancies [3, 4]. However, the studies or cases reported in terms of the usefulness of PET/CT in diff
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