A Rare Case of Metastasis-Induced Acute Pancreatitis in a Patient with Small Cell Carcinoma of the Lung

Abstract

Acute pancreatitis caused by metastatic carcinoma to the pancreas is uncommon. We report a rare case of metastasis-induced acute pancreatitis with small cell carcinoma of the lung. A 49 year old female, smoker, with history of small cell carcinoma with limited disease to the right lung, was admitted with constant epigastric abdominal pain radiating to the back for 4 days. The patient denied any fever, chills, or nausea. One month earlier she had completed 1 cycle of chemotherapy with cisplatin and etoposide. She denied any history of heavy alcohol use or hypertriglyceridemia. On admission, the patient was afebrile and in mild distress. Temperature was 98.1°F, blood pressure was 127/76 mm Hg, pulse was 78/minute, and respiration rate was 20/min. Physical examination revealed mild bibasilar crackles. The bowel sounds were normoactive. Mild tenderness to palpation was noted over the mid-epigastric region without rebound tenderness, guarding, or palpable mass. Laboratory evaluation revealed a lipase of 2206 IU/dL [10–45 IU/dL], white blood cell count of 32.3 × 103/μL [4.8–11.0 × 103/μL], and hematocrit of 29.1%[ 37–47%]. Liver tests and creatinine were all in normal range. CT scan of the abdomen revealed a 2.3 × 2.2 cm hypodense mass in the head of the pancreas without associated pancreatic or common bile duct dilatation. In addition, multiple small liver lesions and a moderate right pleural effusion were noted. To clarify the lesion seen on the pancreas, EUS-guided FNA of the mass in the pancreas was performed. The cytology revealed malignant cells consistent with small cell carcinoma of the lung. The patient was managed conservatively with dietary restriction, narcotics for pain control, and parenteral fluids. Although her pain improved, serum lipase was persistently elevated up to 1000 IU/L. Subsequently, she experienced increasing shortness of breath. She elected for comfort care and died a few days later. Metastasis-induced acute pancreatitis is rare and can occur as the initial presenting manifestation of a carcinoma or late in the course of the disease. Mechanisms of acute pancreatitis in our patient is unclear but may include mass effect on the pancreas and/or mechanical pancreatic duct obstruction. Chemotherapy, surgery and endoscopic intrapancreatic stenting may be considered. However, the overall prognosis, as seen in our case, is extremely poor.