Postgraduate Medicine
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Pancreatic carcinoma presenting as primary lung cancer Yehia Y. Mishriki MD To cite this article: Yehia Y. Mishriki MD (1990) Pancreatic carcinoma presenting as primary lung cancer, Postgraduate Medicine, 87:8, 107-110, DOI: 10.1080/00325481.1990.11704675 To link to this article: http://dx.doi.org/10.1080/00325481.1990.11704675
Published online: 17 May 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [La Trobe University]
Date: 13 June 2016, At: 20:48
Pancreatic carcinoma presenting as primary lung cancer Yehia Y. Mishriki, MD
Downloaded by [La Trobe University] at 20:48 13 June 2016
Preview Because pancreatic cancer often metastasizes to other sites, it may not be diagnosed until autopsy. Pulmonary metastases from the pancreas are not uncommon but unfortunately not often recognized. Dr Mishriki describes a patient with obstruction of the superior vena cava and metastatic pancreatic cancer that was misdiagnosed as primary lung cancer. Autopsy revealed the pancreas to be the primary tumor site.
A 54-year-old woman presented to Wmthrop-University Hospital, Mineola, New York, with shortness of breath and nonproductive cough of several days' duration. She also complained of anorexia, orthopnea, and a sense of fullness in her head and neck. The patient denied having fever, chills, hemoptysis, jaundice, or abdominal or back pain. She smoked cigarettes and was moderately overweight. On physical examination the patient sat bolt upright and was in moderate respiratory distress. Heart rate was 120 beats per minute and respirations were 28/min. Her skin was anicteric and without lesions, but her face was somewhat edematous with slight conjunctival injection. The external jugular veins were distended to the angle of the jaw, and a prominent venous pattern was evident over the superior portion of the chest. The base of the right lung was dull to percussion, and scattered rhonchi were noted in the posterior pan of the right lung. Ex-
arnination of the heart showed no abnormalities. The abdomen was nontender and flat with active bowel sounds. No abdominal masses were present. The liver and spleen were not palpable, and liver span was 10 em by percussion. Results of a rectal examination and stool guaiac testing were normal.
• A PERPLEXING CASE
Veins on the dorsum of the hands were distended and did not collapse when the hands were raised above the chest. Laboratory results were unremarkable except for slight leukocytosis. In particular, results of liver function tests were all normal. A chest film revealed a large mass in
the upper lobe of the right lung impinging on the superior mediastinum. A computed tomographic (en scan of the chest confirmed the presence of the mass and showed involvement of the supenor vena cava. Fine-needle aspiration of the lung lesion guided by cr scan yielded a diagnosis of poorly differentiated adenocarcinoma. The patient received local radiation to the upper pan of the right lung and mediastinum. However, symptoms of superior vena cava obstruction worsened. A cavogram revealed complete thrombosis of the superior vena cava. Further therapy was only supportive, and the patient died 2 weeks later. At autopsy, the primary site of the cancer was found to be the body of the pancreas. Widespread metastases to the liver, peritoneum, heart, lungs, and other sites were evident. The presence of ascites and the absence ofhilar lymph node involvement further substantiated the pancreas as the primary site of the cancer. Discussion
Cancer of the lung is the most prevalent cancer in men and the second most prevalent cancer in women. It is the leading cause of cancer death, accounting for 35% of deaths in men and 20% in women. 1 In contrast, pancreatic cancer is the seventh leading site of continued
VOL87/NO B/JUNE 1990/PQSTGRADUATE MEDICINE •
MNCREAnc CANCa
107
Downloaded by [La Trobe University] at 20:48 13 June 2016
PERPLEXING CASE CONTINUED
cancer in men and the fifth leading site in women, accounting for 3% of all cancers. 1'2 However, it is responsible for a disproportionate 5% of all cancer deaths in both men and women. 3 Pancreatic cancer can present with pulmonary m~~
ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: http://www.tandfonline.com/loi/ipgm20
Pancreatic carcinoma presenting as primary lung cancer Yehia Y. Mishriki MD To cite this article: Yehia Y. Mishriki MD (1990) Pancreatic carcinoma presenting as primary lung cancer, Postgraduate Medicine, 87:8, 107-110, DOI: 10.1080/00325481.1990.11704675 To link to this article: http://dx.doi.org/10.1080/00325481.1990.11704675
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipgm20 Download by: [La Trobe University]
Date: 13 June 2016, At: 20:48
Pancreatic carcinoma presenting as primary lung cancer Yehia Y. Mishriki, MD
Downloaded by [La Trobe University] at 20:48 13 June 2016
Preview Because pancreatic cancer often metastasizes to other sites, it may not be diagnosed until autopsy. Pulmonary metastases from the pancreas are not uncommon but unfortunately not often recognized. Dr Mishriki describes a patient with obstruction of the superior vena cava and metastatic pancreatic cancer that was misdiagnosed as primary lung cancer. Autopsy revealed the pancreas to be the primary tumor site.
A 54-year-old woman presented to Wmthrop-University Hospital, Mineola, New York, with shortness of breath and nonproductive cough of several days' duration. She also complained of anorexia, orthopnea, and a sense of fullness in her head and neck. The patient denied having fever, chills, hemoptysis, jaundice, or abdominal or back pain. She smoked cigarettes and was moderately overweight. On physical examination the patient sat bolt upright and was in moderate respiratory distress. Heart rate was 120 beats per minute and respirations were 28/min. Her skin was anicteric and without lesions, but her face was somewhat edematous with slight conjunctival injection. The external jugular veins were distended to the angle of the jaw, and a prominent venous pattern was evident over the superior portion of the chest. The base of the right lung was dull to percussion, and scattered rhonchi were noted in the posterior pan of the right lung. Ex-
arnination of the heart showed no abnormalities. The abdomen was nontender and flat with active bowel sounds. No abdominal masses were present. The liver and spleen were not palpable, and liver span was 10 em by percussion. Results of a rectal examination and stool guaiac testing were normal.
• A PERPLEXING CASE
Veins on the dorsum of the hands were distended and did not collapse when the hands were raised above the chest. Laboratory results were unremarkable except for slight leukocytosis. In particular, results of liver function tests were all normal. A chest film revealed a large mass in
the upper lobe of the right lung impinging on the superior mediastinum. A computed tomographic (en scan of the chest confirmed the presence of the mass and showed involvement of the supenor vena cava. Fine-needle aspiration of the lung lesion guided by cr scan yielded a diagnosis of poorly differentiated adenocarcinoma. The patient received local radiation to the upper pan of the right lung and mediastinum. However, symptoms of superior vena cava obstruction worsened. A cavogram revealed complete thrombosis of the superior vena cava. Further therapy was only supportive, and the patient died 2 weeks later. At autopsy, the primary site of the cancer was found to be the body of the pancreas. Widespread metastases to the liver, peritoneum, heart, lungs, and other sites were evident. The presence of ascites and the absence ofhilar lymph node involvement further substantiated the pancreas as the primary site of the cancer. Discussion
Cancer of the lung is the most prevalent cancer in men and the second most prevalent cancer in women. It is the leading cause of cancer death, accounting for 35% of deaths in men and 20% in women. 1 In contrast, pancreatic cancer is the seventh leading site of continued
VOL87/NO B/JUNE 1990/PQSTGRADUATE MEDICINE •
MNCREAnc CANCa
107
Downloaded by [La Trobe University] at 20:48 13 June 2016
PERPLEXING CASE CONTINUED
cancer in men and the fifth leading site in women, accounting for 3% of all cancers. 1'2 However, it is responsible for a disproportionate 5% of all cancer deaths in both men and women. 3 Pancreatic cancer can present with pulmonary m~~
