Asymptomatic Small Cell Carcinoma of the Lung Metastatic to the Stomach

Abstract

AIM: To describe a case of asymptomatic small cell carcinoma of the lung, diagnosed through biopsy of metastatic gastric lesions. CASE REPORT: A 68 yo male with a history of DM, hyperlipidemia and Barrett's esophagus underwent routine surveillance upper GI endoscopy (EGD). His only medications included a PPI taken at a standard daily dosage, insulin and atorvastatin. At EGD, a 2 cm segment of Barrett's esophagus (C2M2) was noted and biopsies were negative for dysplasia. Within the gastric body, (2) 6 mm atypical ulcerations were noted which had hypervascular, firm margins. The lesions were “target-like” in appearance (see Figure 1). Biopsies of these lesions were initially interpreted as showing neuroendocrine carcinoma. The liver biochemical test profile was abnormal with the serum AST, ALT and alkaline phosphatase levels all being elevated at ˜5X the upper limit of normal and a fasting serum gastrin level was normal at 36 pg/ml (N=1-115). The normal serum gastrin level suggested the possibility of a sporadic, type 3 gastric carcinoid. As type 3 lesions are usually solitary, the diagnosis was called into question and another pathology opinion was sought. The second pathology interpretation suggested the lesions to be small cell carcinomas. CT scan of the chest and abdomen revealed a 6 cm left hilar tumor with small bilateral pulmonary nodules, numerous malignant-appearing bilobar liver lesions and bilateral adrenal enlargement consistent with metastatic involvement. The patient was started on systemic chemotherapy which included carboplatin and VP-16.Figure 1CONCLUSIONS: The presence of multiple atypical gastric ulcerations with a “target-like” appearance should raise the specter of metastatic disease to the stomach. In this case, the finding led to the diagnosis of an asymptomatic, but widely metastatic small cell carcinoma.