Metastasis-induced acute pancreatitis as the initial manifestation of bronchogenic carcinoma

Metastasis-induced pancreatitis (MIAP) is a very rare initial manifestation of lung cancer. A review of one institution's experience and the English language medical literature was conducted to define the incidence, natural history, and optimal treatment of this unusual clinical problem. One of 802 (0.12 percent) lung cancer patients presented with MIAP. Seven additional cases were found in the literature. Small-cell carcinoma was present in six of eight patients. Prognosis is poor. Four patients died within two weeks of hospital admission. In patients with small-cell carcinoma and mild pancreatitis, chemotherapy may favorably influence recovery from pancreatitis. Those with severe pancreatitis tolerate chemotherapy poorly and initial supportive management is advisable. Patients with small-cell histologic features who recover from pancreatitis should receive chemotherapy. Survival beyond six months is possible.