Dual Synchronous Metastases to Pancreas and the Breast from a Small Cell Lung Cancer: A Case Report

Background: Small cell lung carcinoma (SCLC) is an aggressive subtype of lung tumors with a high rate of metastasis. It usually starts in the lung but can also infiltrate several sites such as the regional lymph nodes, liver, bone, adrenal glands and brain. Since SCLC is often quiescent, the diagnosis is often confirmed by the investigations related to its extra-thoracic manifestations. Several cases reported in literature have isolated other extra-thoracic sites than the aforementioned ones: pancreatic and breast metastatic sites were identified in distinct cases. No previous case report has identified the presence of breast and pancreas metastases simultaneously. Case Presentation: A 64-year-old woman, heavy smoker and alcoholic, presented to the emergency department for acute severe epigastric pain. The abdominal CT scan showed two necrotic masses in the pancreas. Swelling in the right breast and tender subcutaneous nodules were identified on the clinical examination of the neck and the scapula. The mediastinal lymph node enlargement was confirmed through a chest CT scan from which a necrotic lesion of the left lung was identified suggestive of SCLC. A suspicious mass was spotted through a mammogram from which an echo-guided sampling of the breast mass led to the same neoplastic origin. Appropriate treatment was given. Conclusions: This is the first case that identified simultaneous metastases in the breast and pancreas from a primary small cell lung cancer. Despite the inability to confirm the nature pancreatic masses, their synchronous presence in the head and tail is part of extra-thoracic manifestations of SCLC.