TISSUE IS THE ISSUE: SUBCUTANEOUS SMALL CELL CARCINOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Small cell carcinoma is a high grade neuroendocrine tumor often arising within the central airways. The majority of patients present with metastatic disease, most common sites being liver, adrenal glands, bone, and brain. Subcutaneous metastasis occurs uncommonly but bodes more aggressive course poor prognosis. When present, subcutaneous disease can offer an easily accessible biopsy site. CASE PRESENTATION: An 84 year old male, former heavy smoker COPD chronic hypoxic respiratory failure, presents to pulmonology clinic progressive dyspnea significant unintentional weight loss over past several months. He was referred for endobronchial ultrasound obtain tissue relating new bilateral lung masses found incidentally on chest X-ray, dominant right lower lobe mass measuring up 10 cm. Subsequent PET/CT showed multiple FDG-avid pulmonary hepatic masses, mediastinal lymphadenopathy, maxillary sinus mass, superficial soft tissues lesions adjacent left ribs. CT head without contrast revealed two occipital approximately 1 cm each. On physical exam, firm nodule correlating rib lesion palpated, proving less invasive Dermatology expeditiously excised sent it pathology which carcinoma, immunohistochemistry positive CD56 (cytoplasmic), TTF-1 nuclear, CK7 (cytoplasmic/membranous), negative CK20, p40, synaptophysin, chromogranin. Given small in setting large metastases, malignancy consistent origin. Due prognosis, he offered palliative chemotherapy, receiving carboplatin (AUC5) etoposide, as well cranial radiation placement inpatient hospice before dying few months later. DISCUSSION: ominous almost exclusively smoking population hence its propensity nature tendency metastasize early, prompt diagnosis treatment essential. In cases, after has occurred. With involvement, manifest constitutional symptoms, dyspnea, cough. nature, paraneoplastic syndromes may also manifest. Much rarer, cutaneous estimated 1.5-2.6% primary cancers, overlooked by profound burden at presentation. CONCLUSIONS: This case demonstrates importance thorough review diagnostics determine prudent next best step cancer. Though rare, especially cases cancer, presence offers potentially site least biopsy. REFERENCE #1: Barbetakis, Nikolaos, et al. "Facial Skin Metastasis Small-Cell Cancer: Report." Journal Reports, vol. 3, no. 1, 2009, doi:10.1186/1752-1947-3-32. #2: Van Meerbeeck, Jan P, "Small-Cell Cancer." Lancet, 378, 9804, 2011, pp. 1741–1755., doi:10.1016/s0140-6736(11)60165-7. #3: Bobba, Ravi K "Skin metastases non-small cancer." American journal medical sciences 344,1 (2012): 59-62. doi:10.1097/MAJ.0b013e31823e5ec1 DISCLOSURES: No relevant relationships Kyle Blasser, source=Web Response