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• W4387248429 abstract "SESSION TITLE: Lung Cancer: Interesting Lung Cancer Presentations SESSION TYPE: Case Reports PRESENTED ON: 10/11/2023 08:30 am - 09:30 am INTRODUCTION: Amylase is a digestive enzyme released either from the pancreas or the salivary glands. Elevated amylase in pleural fluid is an atypical finding seen in lung malignancy. Hyperamylasemia (elevated serum amylase >110 U/l) is only seen in 1% to 3% of all lung cancer patients. We present a case of adenocarcinoma of the lung with elevated serum and pleural amylase levels in the absence of esophageal or pancreatic pathology. CASE PRESENTATION: A 73-year-old female presented with 3 days of shortness of breath and a ten-pound weight loss over the past year. She had decreased breath sounds in the left lower lung but was saturating at 96% on room air. Labs were remarkable for elevated serum amylase (176 U/l) and lipase (507 U/l). Chest X-ray and computed tomography (CT) of the chest showed a large left pleural effusion with a near collapse of the left lung and pleural-based nodules of the left lung, with the largest measuring 8mm. A CT scan of the abdomen with contrast showed a normal pancreas. The patient then underwent thoracentesis, and the pleural fluid was exudative with high amylase (1627 U/l). Endoscopy and esophagram ruled out an esophageal perforation, lesion, malignancy, or fistula. Pleural fluid cytology revealed malignant cells consistent with lung adenocarcinoma. Video-assisted thoracic surgery showed multiple metastatic implants on the pleural surface and pleural biopsy confirmed adenocarcinoma of the lung, for which appropriate treatment was started. DISCUSSION: The differential diagnosis of a high pleural amylase level primarily includes an esophageal rupture or fistula, pancreatitis, pancreato-pleural fistula, and rarely, malignant pleural effusion. The elevated serum amylase and lipase levels initially raised suspicion for pancreatic or esophageal disease or injury, but subsequent endoscopy, esophagram, and abdominal imaging ruled out pancreatic or esophageal involvement. Reports have shown that malignant lesions have amylase activity levels that exceed those in the serum, indicating that amylase may be produced ectopically in some carcinomatous lung tumors, and that amylase of this origin may cause pronounced and persistent hyperamylasemia. CONCLUSIONS: This case highlights the importance of considering adenocarcinoma of the lung as a potential cause of elevated serum and pleural amylase levels in the setting of pleural effusion. Although rare, it should be included in the differential diagnosis of patients with hyperamylasemia and high pleural amylase levels. Further studies are needed to better understand the relationship between lung cancer and elevated serum amylase to improve the early detection and management of these cases. REFERENCE #1: Lam R, Muniraj T. Hyperamylasemia. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559273/ REFERENCE #2: Kramer MR, Saldana MJ, Cepero RJ, Pitchenik AE. High amylase levels in neoplasm-related pleural effusion. Ann Intern Med. 1989;110(7):567-569. doi:10.7326/0003-4819-110-7-567 REFERENCE #3: Ammann RW, Berk JE, Fridhandler L, Ueda M, Wegmann W. Hyperamylasemia with carcinoma of the lung. Ann Intern Med. 1973;78(4):521-526. doi:10.7326/0003-4819-78-4-521 DISCLOSURES: No relevant relationships by Azeem Arastu No relevant relationships by Tahmina Kushan No relevant relationships by Gehan Mahmoud No relevant relationships by Aisha Mujahid No relevant relationships by Artur Shalonov No relevant relationships by Nadir Siddiqui" @default.
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• W4387248429 date "2023-10-01" @default.
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• W4387248429 title "A CASE OF LUNG ADENOCARCINOMA WITH HIGH PLEURAL AND SERUM AMYLASE LEVEL" @default.
• W4387248429 doi "https://doi.org/10.1016/j.chest.2023.07.2933" @default.
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