A case of metachronous metastasis to the pancreas from rectal cancer

Okumura, Shinya; Yoshimura, Tsunehiro; Fujita, Kumi

doi:10.2958/suizo.29.253

Cited by 5 publications

(6 citation statements)

References 7 publications

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“…Accurate preoperative diagnosis of pancreatic metastasis rather than a primary pancreatic cancer is difficult [7–10,12]. Cytological examination of a fine needle aspirate or pathological examination of a biopsy specimen obtained under endoscopic ultrasonography guidance is useful for preoperative diagnosis [4,8,9,20,21]. In our case, although pathological assessment of a biopsy specimen suggested moderately-differentiated tubular adenocarcinoma, it was not possible to make a definite preoperative diagnosis of pancreatic metastasis originating from rectal cancer, which was regrettable given the impact the diagnosis made on subsequent management.…”

Section: Discussionmentioning

confidence: 99%

“…Optimal treatment for pancreatic metastasis has not yet been established [5,8,10,15,20]. Pancreatic resection may confer a survival benefit on patients with pancreatic metastases [2,5–10,12–15,20], the 5-year survival rate after this procedure reportedly being approximately 30% [23].…”

Section: Discussionmentioning

confidence: 99%

“…The role of intentional lymphadenectomy in patients with pancreatic metastases is controversial [10,12,23]; pancreatic metastasis may be accompanied by lymphoid metastases in regional lymph nodes [8,23]. The mortality and morbidity rates for pancreatic resections including pancreaticoduodenectomy for pancreatic metastasis are reportedly 1.4% and 48.3%, respectively [2].…”

Section: Discussionmentioning

confidence: 99%

“…Metastases to the pancreas account for approximately 2% of pancreatic neoplasms [2]. Pancreatic metastases from colorectal cancer are rare [3–14], and acceptable outcomes can be achieved by curative resection in carefully selected patients [5,6,8,10,12–15]. Treatment guidelines recommend aggressive resection of hematogenous metastases (i.e., lung or liver metastases) [16,17] if radiographic and/or surgical R0 (i.e., radiographic/surgical R0 resection, according to the Japanese Classification of Colorectal, Appendiceal and Anal carcinoma [18]) is accomplished [5,7–10,12,13,15–17].…”

Section: Introductionmentioning

confidence: 99%

“…Whether pancreatic metastases occur via hematogenous pathways is controversial [7–10,12]. Aggressive surgery should be a component of multimodality treatment of metastatic colorectal cancer [5,6,8–10,12–17].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Metachronous Pancreatic Metastasis from Rectal Cancer that Masqueraded as a Primary Pancreatic Cancer: A Rare and Difficult-to-Diagnose Metastatic Tumor in the Pancreas

et al. 2019

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Patient: Male, 70Final Diagnosis: Metachronous pancreatic metastasisSymptoms: NoneMedication: —Clinical Procedure: SurgerySpecialty: Gastroenterology and HepatologyObjective:Rare diseaseBackground:Pancreatic metastasis from colorectal cancer is rare and can masquerade as primary pancreatic cancer.Case Report:A 70-year-old male was diagnosed with advanced rectal cancer with multiple liver metastases. After neoadjuvant chemotherapy, he underwent radical surgery for the primary tumor and hepatectomy for multiple liver metastases. Adjuvant chemotherapies and additional surgeries were subsequently required for recurrences in the liver, lung, and lymph nodes. A diffuse hypovascular nodule in the pancreatic head and a solitary liver metastasis were detected 2.5 years after the initial surgery and he accordingly underwent further chemotherapy. However, the pancreatic tumor progressed, invading the pancreatic duct and biliary tract. Obstructive jaundice finally prompted discontinuation of chemotherapy and he underwent biliary drainage. His diffuse and hypovascular tumor was clinically and radiographically diagnosed as a primary pancreatic cancer. Pancreatic resection for the pancreatic tumor and hepatectomy for the liver metastasis were performed 4.2 years after the initial surgery, achieving radiographic and surgical curative resection. Pathological examination of the surgical specimen resulted in a definitive diagnosis of metachronous pancreatic metastasis from his primary rectal cancer. Despite further chemotherapy, his general condition worsened; however, he remains alive 5.4 years after the initial surgery, with best supportive care.Conclusions:Pancreatic metastasis originating from rectal cancer can masquerade as primary pancreatic cancer clinically and radiologically. Multimodality treatment is mandatory for metastatic colorectal cancer. Aggressive surgeries for pancreatic metastasis should be considered if curative resection appears possible radiographically and/or intraoperatively.

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