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Case Reports
. 2017 Aug 3:2017:bcr2017219527.
doi: 10.1136/bcr-2017-219527.

Small cell lung cancer presenting as unilateral rhinorrhoea

Adam Haymes  1 , Sridhayan Mahalingam  2 , Natasha Choudhury  3
Affiliations
Case Reports

Small cell lung cancer presenting as unilateral rhinorrhoea

Adam Haymes et al. BMJ Case Rep. .

Abstract

The metastatic spread of infraclavicular malignancies to the nasal cavity is rare. We describe the case of a 58-year-old man who presented with a 4-month history of right-sided rhinorrhoea, maxillary hypoesthesia, hyposmia and hypogeusia. Clinical examination revealed an irregular mass within the right nasal cavity. Immunohistochemical analyses of biopsies were consistent with small cell carcinoma of indeterminate origin. A positron emission tomography scan demonstrated extensive mediastinal lymphadenopathy with collapse-consolidation of the right lung's middle lobe and no other sites of metastasis. Following discussion at the lung multidisciplinary team meeting, a diagnosis of metastatic small cell lung cancer (SCLC) was made; the patient was staged with N3, M1b disease and palliative chemo-radiotherapy was started. To the best of our knowledge, this report represents the first documented case of a solitary nasal cavity metastasis arising from a SCLC.

Keywords: ear; head and neck cancer; head and neck surgery; lung cancer (oncology); nose and throat/otolaryngology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Contrast-enhanced axial CT image demonstrating right-sided nasal cavity mass.
Figure 2
Figure 2
Rigid nasendoscopy image demonstrating an irregular, ulcerated, friable mass within the right nasal cavity.
Figure 3
Figure 3
Haematoxylin and eosin stain (x400) demonstrating round blue cell tumour infiltrating around nerve fibre and blood vessel (A). Immunostain (x400) weakly positive for CK7 in tumour cells compared with surface epithelium (B). Immunostain (x200) positive for synaptophysin in tumour and negative in surface epithelium (C). Immunostain (x400) showing diffuse nuclear positivity for TTF-1 (D).
Figure 4
Figure 4
Axial positron emission tomography CT image demonstrating widespread bihilar lymphadenopathy.
See this image and copyright information in PMC

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