A case of small-cell lung cancer with recurrence of solitary pancreatic metastasis detected by FDG-PET/CT

A 63-year-old man visited an outpatient clinic complaining of 3-month continuous cough and left chest pain. He was diagnosed as having small-cell lung cancer with limited disease in the left lung by the bronchoscopy, enhanced CT, FDG-PET/CT and enhanced brain MRI. He received a regime of chemotherapy consisting of six cycles of carboplatin and etoposide with concurrent radiation therapy of 60 Gy. He was evaluated as showing complete response, and prophylactic cranial irradiation was performed. Nine months later, while routine enhanced CT could not detect obvious relapse in the pancreas, abnormal uptake at the pancreas head was detected in fluorine-18 fluorodeoxyglucose positron emission tomography (F-18-FDG-PET)/computed tomography (CT). Transgastric endoscopic ultrasound-guided fine-needle aspiration biopsy of the pancreas head was carried out, which showed small-cell carcinoma. Immunohistochemical staining was positive for thyroid transcription factor-1, synaptophysin, chromogranin A and notably of AE1/AE3. Thus, the patient was diagnosed as having a recurrence of small-cell lung cancer with pancreatic metastasis. He received another four cycles of carboplatin and etoposide for sensitive relapse. The tumor was diminished and showed partial response. We have to be aware of the possibility of solitary metastasis to the pancreas from lung cancer. FDG-PET/CT may be useful for early detection of pancreatic metastasis, leading to the early diagnosis and precise therapy.