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A Rare Case of Occult Small-cell Lung Cancer with Initial Manifestations of Brain Metastases
Ren Seike1, Shun Takao1, Maho Iwasaki1
1Department of Respiratory Medicine, Hiroshima City Hiroshima Citizens Hospital, Japan.
Abstract:
We report a rare case of small-cell lung cancer (SCLC) detected 14 months after the initial manifestation of brain metastases. A 71-year-old man presented with neurological symptoms that led to the resection of brain neuroendocrine carcinoma (NEC). Despite extensive imaging, no primary tumor was detected during the initial visit. Fourteen months later, a lung nodule appeared in the emphysematous bullae in the left upper lobe, which was confirmed as SCLC. Chemotherapy plus durvalumab was administered to control the tumor. This case highlights the diagnostic challenges of occult SCLC and emphasizes that brain NEC should be carefully followed-up, particularly in patients with emphysema.
Insights
This case study details a rare instance of small-cell lung cancer (SCLC) diagnosed 14 months after initial brain metastases. It underscores the diagnostic challenges of occult SCLC and the need for vigilant follow-up in patients with emphysema.
Area of Science:
- Oncology
- Neurology
- Pulmonology
Background:
- Small-cell lung cancer (SCLC) can present with occult primary tumors, leading to delayed diagnosis.
- Brain metastases from neuroendocrine carcinoma (NEC) can be the initial manifestation of SCLC.
- Emphysema may be associated with an increased risk or altered presentation of SCLC.
Purpose of the Study:
- To report a rare case of SCLC initially presenting as brain metastases.
- To highlight the diagnostic difficulties associated with occult SCLC.
- To emphasize the importance of follow-up for brain NEC in patients with emphysema.
Main Methods:
- Case report of a 71-year-old male patient.
- Initial presentation with neurological symptoms leading to brain NEC resection.
- Subsequent detection of SCLC in a lung nodule 14 months later.
- Treatment with chemotherapy and durvalumab.
Main Results:
- A rare case of SCLC was diagnosed 14 months after the initial presentation of brain NEC.
- The primary SCLC was found in emphysematous bullae of the left upper lobe.
- The patient received chemotherapy and durvalumab for tumor control.
Conclusions:
- Occult SCLC poses significant diagnostic challenges, with brain metastases sometimes preceding primary tumor detection.
- Brain NEC warrants careful follow-up, especially in patients with underlying emphysema.
- Early detection and appropriate management are crucial for improving outcomes in SCLC.
