Papillary-cystic neoplasm of the pancreas with multiple hepatic metastases: A case report

Abstract

We report a case of papillary-cystic neoplasm (PCN) of the pancreas in a 42-yr-old woman. Because of complication with multiple hepatic metastases, the patient could not receive radical operation, and was treated palliatively. The right hepatic tumors decreased in volume by an average of 28% (range: 13-54%) following intra-arterial infusion of doxorubicin and gelatine sponge--i.e. chemoembolization therapy. On the other hand, the left lobe tumor increased by 15% in volume following intra-arterial infusion of doxorubicin alone without selective embolization. A subsequent systemic combination chemotherapy (combinations of 5-fluorouracil, doxorubicin and mitomycin-C) was less effective for both the primary and metastatic sites of PCN of the pancreas. Intra-arterial chemoembolization proved useful--as expected--as a palliative measure. Papillary-cystic neoplasm of the pancreas accompanied by hepatic metastasis is very rare. We present herein its clinical behavior and response to the above treatment as documented by CT scan.

Aggressive behaviour of solid-pseudopapillary tumor of the pancreas in adults: A case report and review of the literature

“…in 44 (9%), but the details on treatment and outcome of these patients were not reported. We retrieved 13 patients [7][8][9][10][11][12][13][14][15] previously reported as "invasion of portal and/or mesenteric vein" by Mao et al [3] , two of them [14] were actually "histological venous invasion" and were then excluded from further consideration. Fourteen patients reported after 1995 were also retrieved [16][17][18][19][20][21][22][23][24][25][26][27][28] for a total of 26 patients including our patient, with SPT involving vascular structures (Table 2).…”

“…Fourteen patients reported after 1995 were also retrieved [16][17][18][19][20][21][22][23][24][25][26][27][28] for a total of 26 patients including our patient, with SPT involving vascular structures (Table 2). Liver metastases were also present in three patients [10,16,23] , invasion of colon [22] or peritoneal dissemination [11] in one each. Seventeen patients [7,8,12,13,15,16,[19][20][21][22][23][24]28] underwent vascular resection and reconstruction without operative mortality.…”

“…The mean and median survival periods of time were 36.9 and 36 mo (range 5-84). Nine patients [9][10][11]15,17,[25][26][27] were unresectable because of vascular infiltration, liver metastases or peritoneal dissemination. The mean and median survival periods of time were 55.5 and 47 mo (range 8-156).…”

“…However, we do not know if the long term survival is due to the chemotherapy, or due to the natural course of a less aggressive tumor. The usefulness of chemotherapy for patients with SPT is substantially unknown, although some anecdotal studies have reported its benefit [11,31,40,41] or non benefit [10,17,36] . Two cases of resectable tumor underwent chemotherapy with cisplatin and 5-fluorouracil [40] or gemcitabine [41] , but in the latter patient previous treatment with fluorouracil and 50.4 Gy failed to decrease the tumor size.…”

Deregulated Expression of Cell Cycle–Associated Proteins in Solid Pseudopapillary Tumor of the Pancreas

“…The success of this type of treatment has not been documented, however (5). In one patient with multiple metastases of the liver, chemoembolization proved useful as a palliative measure for tumor regression (43). Liver metastases developed in one patient despite gamma irradiation and chemotherapy of the primary tumor (2).…”