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Life sciences · Journal article
Frontiers in Oncology · October 21, 2026
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Background Small cell lung cancer (SCLC) is a highly malignant neuroendocrine tumor with rapid progression and poor prognosis. Pathological examination is the gold standard for its diagnosis, yet pathological sampling is unfeasible in some clinical scenarios due to various constraints, making imaging and tumor markers critical for clinical decision-making. This two-case report describes the typical computed tomography (CT) findings of SCLC and explores the clinical value of combining CT imaging with tumor markers in guiding the diagnosis and treatment of SCLC patients for whom pathological confirmation is not feasible. Case report We report two SCLC cases: Case 1 was a 56-year-old male with pathologically confirmed SCLC who presented typical imaging findings of hilar and mediastinal fused lymph nodes and achieved a partial response after combined chemoradiotherapy. Case 2 was a 67-year-old male with chest tightness and hemoptysis for 2 months, whose chest CT showed fused lymph nodes (a typical SCLC feature) and markedly elevated neuron-specific enolase (NSE: 221 ng/mL; reference range 1-16.2 ng/mL). Biopsy was unfeasible due to recent coronary stenting and ongoing antiplatelet therapy, and a clinical diagnosis of limited-stage SCLC was made via a combination of typical CT imaging features, significantly elevated NSE and clinical symptoms. The patient received timely EC regimen chemotherapy and subsequent standard chemoradiotherapy, which resulted in a clinical complete response (CR). Conclusions This case report details the typical CT manifestations of SCLC and demonstrates that the combined application of typical CT findings, tumor markers and clinical symptoms may provide a pragmatic basis for timely clinical diagnosis and treatment of SCLC patients when pathological sampling is not achievable. This approach may help avoid treatment delay and improve clinical outcomes for such patients, while emphasizing that pathological examination remains the gold standard for SCLC diagnosis.