Pleural Small Cell Lung Carcinoma: An Unusual Culprit in Pleural Effusion

Our plain-English summary of Pleural Small Cell Lung Carcinoma: An Unusual Culprit in Pleural Effusion, by O.D. Adejorin, A. Sodhi, F.A. Hare, et al (The American Journal of Case Reports, 2015).

The study

• Authors: O.D. Adejorin, A. Sodhi, F.A. Hare, A.S. Headley, L.C. Murillo, D. Kadaria
• Journal: The American Journal of Case Reports
• Published: 2015;16:912-5
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Small cell lung carcinoma (SCLC) usually presents as lung or mediastinal lesions. It is very rare for SCLC to present primarily as an isolated pleural effusion with no lung or mediastinal lesions.

Case Report: We report the case of a 77-year-old white male with a 60-pack year history of smoking, chronic obstructive pulmonary disease (stage IV), and asbestos exposure who presented with shortness of breath and left lateral chest pain for 7 days. On physical examination, he was very short of breath, with a prolonged expiratory phase on chest auscultation. Laboratory results were normal except for leukocytosis and chest radiograph revealing left-sided pleural effusion. Computerized tomography (CT) scanning of the chest with IV contrast showed left-sided pleural effusion without any lung or mediastinal lesions. Thoracentesis was performed and fluid was sent for analysis. Repeat CT chest/abdomen/pelvis, done immediately following thoracocentesis, did not show any masses or lymphadenopathy. Fluid analysis, including cytology and immunostain pattern, was consistent with small cell carcinoma.

Conclusions: Small cell lung cancer presenting as an isolated pleural effusion is extremely rare. It requires close attention to cytology and immunohistochemistry of pleural fluid samples. It also has implications for management and should be managed as limited-stage SCLC.

In plain English

This case report describes one patient: a 77-year-old white man with a 60-pack-year smoking history, stage IV chronic obstructive pulmonary disease (COPD) and asbestos exposure. He had seven days of shortness of breath and left-sided chest pain. A chest X-ray and CT scan showed fluid around the left lung (a pleural effusion) but no lung or mediastinal lesions. The fluid was drained, built up again within 24 hours and was drained again. A repeat CT of the chest, abdomen and pelvis showed no masses or enlarged lymph nodes. Tumor cells in the fluid were weakly positive for the marker CD56. Their staining pattern and appearance were consistent with small cell carcinoma. Because of poor functional status and his preference, he was referred for hospice care. The report gives no details of the asbestos exposure and does not discuss whether it played any role. The authors concluded that small cell lung cancer presenting as an isolated pleural effusion is extremely rare, needs careful cytology and immunohistochemistry of the fluid, and should be managed as limited-stage disease.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: one 77-year-old white man with a 60-pack-year smoking history, stage IV COPD and asbestos exposure; the authors are from a pulmonary department at the University of Tennessee Health Science Center, Memphis
• Exposure: asbestos exposure is listed in the patient's history alongside heavy smoking; no fiber type, job, duration or dose is given
• Main results:
  • CT of the chest showed a left-sided pleural effusion with no lung lesions or mediastinal lymph node enlargement
  • The fluid built up again within 24 hours and was drained a second time
  • A repeat CT of the chest, abdomen and pelvis after drainage showed no masses or enlarged lymph nodes
  • Tumor cells in the pleural fluid were weakly positive for CD56
  • The staining pattern together with the cells' appearance was consistent with small cell carcinoma
  • Because of poor functional status (stage IV COPD with oxygen dependence and limited mobility) and patient preference, the patient was referred for hospice care
• The authors' conclusion: The authors concluded that small cell lung cancer presenting as an isolated pleural effusion is extremely rare, requires close attention to cytology and immunohistochemistry of the pleural fluid, and should be managed as limited-stage small cell lung cancer

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Pleural Effusion, Asbestos Exposure, Chest X-Ray, Thoracentesis, Lymphadenopathy, Cytology, Small Cell Lung Cancer.

Related studies

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• Small cell carcinoma presenting with massive pleural spread mimicking malignant pleural mesothelioma — T. Takeda, M. Saitoh, et al. (2014)
• Pleural small cell carcinoma with massive pleural effusion: A case report — J.G. Jang, M.H. Jang, et al. (2019)
• Pseudomesotheliomatous small-cell neuroendocrine carcinoma of the lung with calretinin expression — G.D. Exarchos, R.L. Attanoos (2015)
• Small cell mesothelioma: A rare entity and diagnostic pitfall mimicking small cell lung carcinoma on fine-needle aspiration — Y. Zhang, A. Afify, et al. (2016)
• Primary small cell carcinoma of the pleura: a case report with immunohistochemical and molecular genetic analyses of KIT and PDGFRA genes — T. Terada (2010)

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