Cutaneous Lesions: An Unusual Clinical Presentation of Small Cell Lung Cancer.

BACKGROUND Small cell lung cancer (SCLC) is the most aggressive type of lung cancer, accounting for 13% of all new lung cancer cases worldwide. Common metastatic sites are the brain, liver, adrenal glands, bone, and bone marrow, while cutaneous metastasis is rare and is associated with a poor prognosis, and presentation of SCLC as the first sign of malignancy is even rarer. CASE REPORT An 87-year-old patient with a history of tobacco abuse and free from any medication administration presented to the Emergency Surgical Department with 2 nodules in the skin of the abdomen. Excisional biopsy of the skin lesions was performed and the pathology showed metastatic small cell cancer originated from the lungs. A chest X-ray and CT scan confirmed the diagnosis of lung cancer. Chemotherapy was initiated. Following a short hospitalization period, the patient's condition worsened. The patient died in the Intensive Care Unit before completion of full cycles of chemotherapy and palliative radiation therapy. CONCLUSIONS A diagnosis of metastatic disease should be considered in patients with new cutaneous lesions and a smoking history. Skin lesions of metastatic lung cancer are often described as painless nodules, mobile or fixed, hard or flexible, single or multiple. Treatment in limited-stage disease usually includes chemotherapy combined with radiation. In extensive-stage disease, chemotherapy is the primary option. Small cell lung carcinoma is more responsive to chemotherapy and radiation therapy than are other cell types of lung cancer. For prevention, especially in high-risk patients, annual chest screening, smoking-prevention programs, and control of occupational exposure to culprit substances are highly recommended.

Intrathyroidal parathyroid adenoma mimicking thyroid cancer.

Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia; patients are usually asymptomatic and the cause in 80-85% of cases is a single parathyroid adenoma (PA). Parathyroid adenomas arise from clonal expansion of tumor cells and may be located either posteriorly to the thyroid lobes or in ectopic sites. The incidence of intrathyroidal PAs varies from 1% to 6% and although uncommon, they pose certain diagnostic difficulties which may complicate treatment. The identification of the adenoma requires a combination of clinical evidence, imaging information and cytological findings due to the challenging distinction between thyroid and parathyroid lesions. We present the case of a patient with a large, partially cystic intrathyroidal parathyroid adenoma which was initially identified as a malignant thyroid nodule. We discuss the caveats that present in these rare cases and the important clinical and histological features that aid in the final diagnosis. In the case of our patient the cytological similarities between thyroid malignant cells and parathyroid cells, in combination with the negative sestamibi scan, resulted in a more invasive surgery than that a single parathyroid adenoma would require. Clinicians need to be vigilant in terms of the similarities between parathyroid and thyroid cytology in order to provide optimal patient care in these rare cases.