Pancreatitis from metastatic small cell lung cancer successful treatment with endoscopic intrapancreatic stenting

Abstract

Lung cancer metastases can occur in almost any organ. However, metastasis of small cell lung cancer to the pancreas is rare. Moreover, not all cases present with clinically diagnosed pancreatitis. We recently treated a patient with small cell lung carcinoma that invaded the pancreatic duct causing acute pancreatitis. Generally, the treatment for tumor-induced acute pancreatitis is initially supportive followed by aggressive chemotherapy or surgery. If the patient can tolerate the insertion of an endoscopic intrapancreatic stent, this is performed in addition to chemotherapy and surgery; this approach offers a safe and effective treatment modality for such patients.

Figure 1

Computed tomography of the abdomen shows multiple low attenuated masses (arrows) at the pancreatic head (A) and a dilatation of the upstream pancreatic duct (arrows) (B). CT also reveals a left adrenal mass of 6.8 × 5.3 cm.

Figure 2

Endoscopic ultrasonography reveals several, well demarcated, irregular hypoechoic masses at the head portion of the pancreas, which compressed the pancreatic duct (arrow).

Figure 3

Endoscopic retrograde pancreatography reveals an irregular stricture of the pancreatic duct (arrow) at the head portion of the pancreas, along with mild dilatation of the upstream pancreatic duct (A). A 5 Fr pancreatic stent (arrow), 9 cm in length, was inserted at the pancreatic duct through the stenotic area (B).