Acute pancreatitis combined with acute Budd-Chiari syndrome as the initial manifestation of small cell lung cancer
Journal
Journal of the Formosan Medical Association
Journal Volume
104
Journal Issue
6
Pages
431-435
Date Issued
2005
Author(s)
Abstract
Tumor metastasis to the pancreas is a rare but recognized cause of acute pancreatitis. Autopsy series have reported a 24-40% of pancreatic involvement in small cell lung cancer. However, only a very few cases of tumor-induced acute pancreatitis have been described. Budd-Chiari syndrome complicating lung cancer is a rarely reported condition. We report a 68-year-old woman with extensive small cell lung cancer with the unusual initial presentation of both acute pancreatitis and acute Budd-Chiari syndrome. This patient suffered from progressive epigastralgia for 3 weeks. Severe epigastralgia with radiation to back and progressive jaundice developed 2 days prior to admission. After admission, the liver enlarged rapidly and the ascites increased markedly. Chest roentgenogram showed a mass lesion over the left lower lung field. Poorly differentiated carcinoma cells were found in ascites and bone marrow. The patient died on the ninth day of hospitalization before chemotherapy was initiated. Prompt diagnosis of extensive-stage small cell lung cancer may allow early chemotherapy treatment which favorably influences recovery when the pancreatitis is mild. Although prolonged survival might have been expected had this patient recovered from pancreatitis and received chemotherapy, diagnosis was delayed due to difficulty in immunohistochemical diagnosis of the tumor and the unusual clinical presentation. The use of stains employing antibodies against neurofilament and neuron-specific enolase cell antigens is important for early diagnosis of poorly differentiated metastatic tumor cells.
SDGs
Other Subjects
acute pancreatitis; aged; anamnesis; article; ascites; bone marrow biopsy; Budd Chiari syndrome; case report; cell differentiation; clinical feature; disease severity; epigastric pain; female; hepatomegaly; hospital admission; hospitalization; human; human cell; human tissue; immunohistochemistry; jaundice; laboratory test; lung small cell cancer; neurologic examination; physical examination; radiodiagnosis; acute disease; liver vein thrombosis; lung tumor; pancreatitis; pathology; small cell carcinoma; Acute Disease; Aged; Carcinoma, Small Cell; Female; Hepatic Vein Thrombosis; Humans; Lung Neoplasms; Pancreatitis
Type
journal article