Shah Ejaz, Abro Calvin
Internal Medicine, Saint John Hospital, Springfield, Illinois, USA.
Hematology and Oncology, Southern Illinois University, Springfield, Illinois, USA.
Case Rep Oncol. 2022 Jun 30;15(2):668-673. doi: 10.1159/000525279. eCollection 2022 May-Aug.
Extrapulmonary small cell carcinoma (EPSCC) is a rare cancer with a poor prognosis. It can arise from almost any site and is usually associated with extensive metastasis at the time of diagnosis. Due to the rarity of this cancer, very limited data is available in the literature and most of the recommendations for its evaluation and treatment are based on retrospective studies and expert opinion. This case report shares one such presentation of EPSCC. A 78-year-old male was admitted to the hospital with presenting symptoms of abdominal pain and discoloration of the eyes and urine for 2 months. Initial laboratory investigation revealed obstructive jaundice and leukocytosis. His infectious workup was negative. An ultrasound abdomen was performed, showing multiple liver deposits. He received a computed tomography chest, abdomen, and pelvis with contrast also showing multiple liver deposits highly indicative of metastatic disease. No other obvious abnormality or mass in other visceral organs was reported. He underwent endoscopy and endoscopic retrograde cholangiopancreatography, showing normal pancreatic-biliary ducts. A plastic stent was deployed to help with biliary drainage. A liver biopsy was performed and showed poorly differentiated small cell carcinoma of extrapulmonary origin. His abdominal pain improved after stent placement; however, liver tests continued to worsen. During his hospital stay, he was seen by oncology and given metastatic disease; he was offered palliative chemotherapy. Understanding his poor prognosis, the patient himself opted for comfort care and decided to go home with hospice care. Within days, he became lethargic, likely secondary to hepatic encephalopathy, and expired in the span of the next few days.
肺外小细胞癌（EPSCC）是一种罕见的癌症，预后较差。它几乎可起源于任何部位，通常在诊断时就伴有广泛转移。由于这种癌症罕见，文献中的数据非常有限，其评估和治疗的大多数建议基于回顾性研究和专家意见。本病例报告分享了一例EPSCC的病例。一名78岁男性因腹痛、眼睛和尿液变色2个月入院。初步实验室检查显示梗阻性黄疸和白细胞增多。他的感染性检查结果为阴性。进行了腹部超声检查，显示肝脏有多个病灶。他接受了胸部、腹部和骨盆的增强计算机断层扫描，也显示肝脏有多个病灶，高度提示转移性疾病。未报告其他内脏器官有明显异常或肿块。他接受了内镜检查和内镜逆行胰胆管造影，显示胰胆管正常。放置了一个塑料支架以帮助胆汁引流。进行了肝脏活检，显示为肺外起源的低分化小细胞癌。放置支架后他的腹痛有所改善；然而，肝功能检查仍继续恶化。在住院期间，肿瘤学专家对他进行了会诊，诊断为转移性疾病，并为他提供了姑息化疗。由于了解到预后不佳，患者本人选择了舒适护理，并决定接受临终关怀回家。几天内，他变得嗜睡，可能继发于肝性脑病，并在接下来的几天内去世。
