Obstructive jaundice, a rare presentation of lung cancer: A case report.

Lung cancer metastases to the pancreas are rare but potentially life-threatening. Oftentimes, the presence of symptoms is indicative of extensive disease burden. This report describes a case of primary lung adenocarcinoma metastasizing to the head of the pancreas presenting as obstructive jaundice. The patient was a 61-year-old female veteran who presented with a chronic dyspnea, weight loss, and 3-weeks of nausea and vomiting found to have jaundice, elevated alkaline phosphatase levels, hyperbilirubinemia, and transaminitis. Imaging of her chest revealed large pulmonary parenchymal nodules throughout both lungs with a large left lower lobe mass and consolidation. Abdominal imaging showed a large heterogeneous mass in the pancreatic head, a grossly dilated common bile duct, and enlarged retroperitoneal lymph nodes contiguous with the mass. Pancreatic head biopsies revealed metastatic cancer cells from her lung adenocarcinoma which was confirmed via cytology and the presence of thyroid transcription factor - 1 and cytokeritin-7 expression and the absence of tumor protein 63 staining. Lung adenocarcinomas commonly metastasize to the bones, liver, and central nervous system but very rarely to the pancreas. There have been only a few reported cases of pancreatic tumors that manifested clinically as a result of primary lung cancer metastases however, even though uncommon, hematogenous spread of cancerous tissue should be considered on the differential as a cause for obstructive jaundice in the setting of lung adenocarcinoma.
Competing Interests: No disclosures, conflicts of interest, or competing interests to declare. No prior publications. Consent was obtained by patient's family for publication of case report. There are no conflicts of interest to disclose and the institute's Department of Pulmonary and Critical Care at Rutgers University Hospital New Jersey Medical School and VA New Jersey Healthcare System East Orange Veterans Affairs is fully aware of this submission. All authors listed have contributed to the project and had full access to all aspects of the research and writing process. All equally contributed patient data collection and interpretation, as well as drafting and approving of the final report.
(© 2021 The Author(s).)