A Case of Metastatic Uterine Tumor Originating from Small-Cell Lung Cancer (SCLC) Mimicking Uterine Sarcoma

Metastatic uterine tumors originating from extragenital cancers are a rare clinical occurrence. We report a case of metastatic uterine cancer derived from small-cell lung cancer (SCLC) that necessitated surgical treatment. The patient was a 59 y/o female who had undergone chemotherapy for stage IIIB SCLC. A 15 cm uterine tumor lesion was initially detected on CT scans. The patient had previously been diagnosed with uterine fibroids, but compared to the most recent CT scans taken one and a half months earlier, imaging diagnosis revealed a sudden increase in the size of the tumor when compared to the 8 cm myoma fibroid noted previously. Additional work-up with MRI scans revealed T2-enhanced images of a tumor that had almost completely invaded the myometrium; the tumor presented with marked diffusion-weighted enhancement, and a flow void was noted within the tumor. A differential diagnosis of uterine sarcoma was considered, but due to the lack of focal hemorrhage or necrosis findings on MRI imaging, the possibility of differential diagnosis of metastatic SCLC was also noted. As the patient was experiencing abdominal symptoms including abdominal distension and tenderness due the tumor, a simple hysterectomy and bilateral salpingo-oophorectomy were performed to palliate the symptoms. During the surgical procedures, intra-abdominal findings noted peritoneal dissemination while intraoperative cell cytology diagnosis of ascites revealed small-cell cancer. The final histopathological diagnosis likewise revealed metastatic small-cell cancer from the primary lung cancer. The clinical status of the lung cancer was evaluated as progressive disease (PD), and a change in chemotherapy regimen was necessitated. Further disease progression was noted on CT scans at 2 and a half months after surgery, and with gradual systemic disease progression, the patient died of disease at 3 months postsurgery. Initial evaluation of rapidly enlarging uterine tumors should include a differential diagnosis of uterine sarcoma; additionally, it is necessary to also consider the rare possibility of metastatic disease as in the present case with a clinical history of extragenital malignancy.

Threatening incidence trends of genitourinary small cell cancer.

e17059 Background: Genitourinary localization (GU) is the most frequent extrapulmonary localization of small cell cancer (SCC). The goal of our study was to evaluate incidence trends of GU SCC (bladder (BC) and prostate (PC) in recent years, compare odds ratio (OR) and survival trends. Methods: SEER research data 18 registries, November 2019 Submission (2000-2017) was assessed for SCC histology codes 8041-8043. Patients 20 years and older were included. Age adjusted ratio for 2000 US standard population were used to calculate trends. Race groups were defined as Caucasians (White), African Americans (Black) and Other (included Asians and Native Americans). Stages were defined as localized, regional and distant. Linear regression, chi-square, log-rank test were used to estimate linear trends, OR and hazard ratios (HR). GraphPad Prism 9 (San Diego, CA) was used for analysis. Results: 1423 BC, 544 PC cases were identified. Both BC (R2 0.6151, p 0.0001) and PC (R2 0.8409, p < 0.0001) showed statistically significant (SS) growth of cases. Annual percent change (APC) was 7.2% for PC and 6.8% for BC (p < 0.05 for both groups). PC showed increase number of cases among Caucasians (R2 0.6236, p < 0.0001) and African-Americans (R2 0.3293, p 0.0128). BC showed increase number of cases only among Caucasians (R2 0.8556, p < 0.0001). Caucasian had SS increased OR compared to African Americans and Other for BC (3,503, p 0.0021 and 3.277, p 0.018 respectively). Trend analysis among the disease extend showed that in BC has SS growth was among localized (R2 0.7337, p < 0.0001), regional (R2 0.4212, p 0.0036) and distant (R2 0.7801, < 0.0001). For PC SS growth in number of cases was observed only in regional (R2 0.34565, 0.0109), and distant stage (R2 0.565, p 0.0003). Patients with BC had SS better survival compared to BC (HR 0.69, p < 0.0001). The analysis within both groups showed worse survival with more advanced stage (HR 1.52, p 0.0236 in regional, HR 2.28, p < 0.0001 in distant for PC; HR 1.27, p 0.0038 in regional, HR 2.93, p < 0.0001 in distant for BC). Differentiation of the tumor grade was associated with worse survival in PC group (HR 4.46, p < 0.0001 for poorly differentiated and HR 4.8, P < 0.0001 for undifferentiated compared to moderately differentiated). African American and Other races had better survival compared to Caucasians in patients with BC (HR 0.29, p 0.0021 and HR 0.31, p 0.0018 respectively). Conclusions: GU SCC is a rare type of cancer, that is rapidly growing (APC 7.2% (PC) and 6.8% (BC). The number of cases is growing among Caucasians (BC and PC) and African Americans (PC). Caucasian is a risk factor for developing BC SCC, as well as worse outcomes compared to the other racial groups. The analysis showed that increase of distant stage of GU SCC at the time of diagnosis increase among both BC and PC. Patients with PC had worse survival compared to the BC. Survival tend to be worse in more advanced stages in both groups, but differentiation of the tumor affect survival only in PC patients.

Extrapulmonary Small Cell Cancer: A New Insight into a Rare Disease

<b><i>Introduction:</i></b> Extrapulmonary small-cell cancer (EPSCC) is a relatively rare malignancy. The management of EPSCC is usually extrapolated from small-cell lung cancer (SCLC). In spite of the morphological similarity of the 2 malignancies, there are many differences in clinical features, prognosis, and recommendations of treatment of these disorders. The data on the correlation of clinical-pathological characteristics of EPSCC and treatment results is scarce. <b><i>Materials and Methods:</i></b> This retrospective analysis of 41 consecutively treated patients diagnosed with EPSCC in 2015–2018 was performed in a tertiary medical center. The correlation between the clinical and pathological characteristics and the treatment outcome (response rate, disease-free interval, and overall medial survival) was done using the standard statistics, Kaplan-Meier method, and multivariate analyses. The stratification was done on the stage of the disease, Ki-67 proliferative index, the location of the tumor, and smoking. <b><i>Results:</i></b> Forty-one patients were included with a median age of 66.3 years. The most common primary site was the gastrointestinal tract (28, 68.3%) including the pancreas. The most common distant metastasis site was the liver (23, 56.1%). Only 2 patients (4.9%) had brain metastases. Unlike in SCLC, most patients did not have any history of smoking (23, 56.1%). Nineteen patients with metastatic disease received systemic treatment, mostly cisplatin-based chemotherapy, with a response rate of 57.9%. The results of treatment were significantly better in patients with disseminated EPSCC with Ki-67 &#x3c;55%, while its role in limited disease was nonsignificant. <b><i>Discussion:</i></b> The results of our study show the unique entity of EPSCC. The rarity of brain metastases proves that prophylactic brain irradiation should not be recommended in practice. The provocative idea of prophylactic liver irradiation in limited-stage EPSCC of gastrointestinal origin can be evaluated in future studies. The predictive role of Ki-67 is important in metastatic EPSCC. There is probably no role of smoking in developing EPSCC.