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Case Reports in Oncological Medicine
Volume 2014, Article ID 268404, 4 pages
Case Report

An Innocent Appearing Subcutaneous Nodule Diagnoses a Small Cell Lung Cancer in a Never-Smoker Female

1Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA
2Department of Pathology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY 10457, USA

Received 5 December 2013; Accepted 6 February 2014; Published 10 March 2014

Academic Editors: L. Beex, P. F. Lenehan, J. I. Mayordomo, and N. Yoshimura

Copyright © 2014 Nupur Sinha et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Lung cancer among never-smokers is recognized as the 7th most common cause of cancer death globally. Adenocarcinoma is the most commonly reported histology. Small cell lung cancer (SCLC) has the strongest association with smoking and is rarely reported in never-smokers. Although lung cancer in never-smokers is more common in women, the overall incidence of SCLC in female never-smokers still remains low. Soft tissue metastases from any cancer are rare with an overall prevalence of 1.8%. Soft tissue metastases from lung primary are uncommon, mostly from adenocarcinoma, and portend a poor prognosis. Cutaneous metastases from SCLC are exceptionally rare with reported incidence of 0.3% to 0.8%. We believe ours is the first reported case of SCLC presenting as subcutaneous nodule, in a never-smoker, otherwise asymptomatic female. The diagnosis of SCLC was made incidentally by the excisional biopsy of the subcutaneous nodule. Subsequent CT chest and PET scan revealed a hypermetabolic right lower lobe spiculated lung mass with adrenal and liver involvement. Platinum and etoposide chemotherapy with prophylactic cranial irradiation was initiated for advanced SCLC, and she required further irinotecan and taxol for subsequent pancreatic and adrenal metastases. With continued deterioration, she died approximately 36 months from diagnosis, while under hospice care.