Urgent distal pancreatectomy for intraperitoneal hemorrhage due to the spontaneous rupture of a pancreatic metastatic tumor from synovial sarcoma: a case report

Abstract

Background: Synovial sarcoma is a soft tissue malignancy that frequently affects the extremities, adjacent to the large joints. Synovial sarcoma has a high rate of distant metastasis; however, pancreatic metastasis is extremely rare, and to our knowledge, there has been no report of bleeding due to spontaneous tumor rupture. This study reports the case of a patient with synovial sarcoma pancreatic metastasis causing tumor rupture and bleeding, which was successfully managed with emergent distal pancreatectomy. Case presentation: A 27-year-old woman underwent extensive resection of the primary tumor and partial lung resection after chemotherapy for left femoral synovial sarcoma and multiple lung metastases 4 years prior. During the follow-up, a 35-mm tumor was noted in the pancreatic tail on abdominal computed tomography (CT), and no other distant metastases were detected via positron emission tomography CT. Laparoscopic distal pancreatectomy was scheduled for pancreatic metastasis of synovial sarcoma. However, before the scheduled pancreatectomy could be conducted, the patient visited the emergency department because of abdominal pain that occurred after consuming a small amount of alcohol, and CT showed ascites with high CT values and leakage of contrast media. She was diagnosed with intra-abdominal hemorrhage due to a ruptured metastatic pancreatic tumor, and an emergency operation was performed. In total, 1500 mL of blood was evacuated from the abdomen, and the bleeding pancreatic tail tumor was resected. Histopathological findings revealed synovial sarcoma metastasis and a ruptured tumor capsule, and tumor cells were observed in the hematoma. After discharge on postoperative day 18, the patient was carefully monitored and confirmed to be in relapse-free survival, without chemotherapy, at 6 months post-surgery.

Early progression of a pancreatic metastasis of synovial sarcoma after pancreatectomy

“…In a previous literature review of pancreatic metastases, most lesions were metastases of renal cell carcinoma (62.6–70.1%), followed by melanoma (4.0–9.1%), colorectal carcinoma (6.2–8.9%), and sarcoma (4.3–7.2%) [ 7 , 8 ]. Pancreatic metastasis of SS is extremely rare; only seven cases have been reported worldwide, including our case, as summarized in Table 1 [ 9 – 14 ].…”

“…Pancreatic metastasis of SS is extremely rare; only seven cases have been reported worldwide, including our case, as summarized in Table 1 [ 9 – 14 ].…”

Spontaneous Pancreatic Hemorrhage: Successful Conservative Management in Two Cases

“…Interventional radiology is a safe and effective treatment, involving selective intra-arterial embolization and deployment of stent-grafts over the punctured vessel [ 3 ]. Only patients who develop severe complications such as abdominal hypertension syndrome and obstruction after conservative or interventional treatment require surgical treatment [ 4 , 13 ]. A 74-year-old man underwent pancreaticoduodenectomy due to the risk of malignancy and the possibility of re-bleeding [ 4 ].…”

Spontaneous rupture of an undifferentiated carcinoma with osteoclast-like giant cells of the pancreas presenting as intra-abdominal bleeding: a case report

“…However, a pancreatic tumor is an extremely rare source of spontaneous intra-abdominal bleeding. A review of the literature revealed only 10 previous case reports of spontaneous rupture of pancreatic tumors such as mucinous cyst neoplasms [12,13], pancreatic neuroendocrine cell tumors [14,15], solid cystic tumors [16,17], acinar cell carcinoma [18], pancreatoblastoma [19], and metastasis from other cancers [20,21]. To the best of our knowledge, no previous English-language report has described spontaneous intra-abdominal bleeding due to rupture of UCP.…”