Case of the Month Heidi Menga, PA-C
as showing a thin left subdural hemor- in men, lung cancer accounts for
rhage with meningeal enhancement and 28% of all cancer deaths, with SCLC
diffuse left hemispheric edema causing encompassing 18% of those deaths.2
mass effect on the ventricle and midline Dissemination to regional lymph nodes
shift. Most significant was that the soft (limited-stage) or distant metastasis be-
tissue involvement extended from the yond the hemithorax (extensive-stage)
occiput to the parietal and temporal to the brain, liver, bone, or pleura is
regions on the left scalp. A brain MRI often present at diagnosis. Brain metas-
with contrast demonstrated an apparent tasis is found in approximately 10% of
diffuse left-sided subdural hematoma patients at the time of initial diagnosis.3
with edema and a hypodense left tem- SCLC responds well to chemother-
poral region and confirmed the left- apy, but tumors often recur as they
FIGURE 1 scalp soft tissue involvement (Figure 1). become resistant to the drugs. In
Soft tissue involvement seen on axial MRI extensive-stage tumors, the response
›WHAT IS YOUR DIAGNOSIS? rate is 65% to 85%; 1% to 5% of patients
• Subdural hematoma with achieve a complete response. With treat-
›CASE cephalohematoma ment, the median life expectancy of a
A 61-year-old man presented to the • Undifferentiated small cell carcinoma patient with extensive-stage disease is 9
emergency department (ED) in • Lymphoma months; the 2-year survival rate is less
January 2008 complaining of a tender than 3%.1 Treatment administration
bump on the back of his head. He ›DISCUSSION for more than 6 months has not been
denied any recent trauma but reported The patient underwent subtotal resection found to improve survival.3 Radiation
watering of the left eye and ringing in of the scalp tumor. Pathology confirmed therapy is important for palliation of
the left ear. CT of his head was sig- the tumor to be an undifferentiated small symptoms. Patients with extensive-stage
nificant for an old right basal ganglia cell cancer. Despite a normal-appearing disease survive longer when two or
lacunar infarct, but there were no acute chest radiograph, the patient underwent more drugs are used, compared with
findings. He was discharged with a CT of his chest along with positron single-agent therapy or low-dose regi-
diagnosis of conjunctivitis. emission tomography (PET). Both scans mens. Commonly used agents include
In March 2008, the man returned confirm