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Nakajima Y, Iwasaki E, Kayashima A, Machida Y, Kawasaki S, Horibe M, Kawaida M, Masugi Y, Iwata T, Kanai T. Successful radiotherapy for recurrent obstructive pancreatitis secondary to pancreatic metastasis from cervical squamous-cell carcinoma. Clin J Gastroenterol 2023; 16:755-760. [PMID: 37269479 DOI: 10.1007/s12328-023-01817-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
Metastatic pancreatic cancer is a rare condition and cases of pancreatic metastasis from cervical cancer are infrequently reported. Furthermore, the incidence rates of pancreatic tumors as the cause of pancreatitis and of pancreatitis in patients with pancreatic tumors are similarly low. Pancreatitis may occur when a tumor obstructs the pancreatic duct. This condition may be difficult to manage and significantly reduces the quality of life because of severe abdominal pain. Here, we present a rare case of obstructive pancreatitis caused by pancreatic metastasis from cervical squamous-cell carcinoma, pathologically confirmed using endoscopic ultrasonography-guided fine-needle biopsy and treated with palliative irradiation to achieve rapid therapeutic relief. It is important to obtain appropriate tissue samples, confirm the pathological diagnosis, and compare the pathological findings with those of the primary tumor to select the appropriate treatment for obstructive pancreatitis caused by a metastatic pancreatic tumor.
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Affiliation(s)
- Yuki Nakajima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Atsuto Kayashima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yujiro Machida
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shintaro Kawasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Miho Kawaida
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Masugi
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
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Gupta PK, Lal P, Tiwari A. A case report of carcinoma of uterine cervix throwing heterochronous metastasis to the skin, spleen, and pancreas: the role of multimodality treatment approach. J Egypt Natl Canc Inst 2019; 31:8. [PMID: 32372163 DOI: 10.1186/s43046-019-0009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer of cervix often fails locally and/or within the pelvis. One to two percent of cervical squamous cell carcinoma patients have lung metastases at presentation, and 5-35% develop pulmonary metastases later on. Common sites of metastases are the liver, bone, and bowel. We report a rare case presentation of cervical squamous cell cancer where heterochronous metastasis occurred in the skin, spleen, and pancreas without loco-regional recurrence and skipping of visceral organs such as the lung, liver, and brain. CASE PRESENTATION A 55-year-old, postmenopausal lady presented with a complaint of bleeding of the vagina for 2 months duration. Cervical biopsy revealed squamous cell carcinoma of the cervix, and she was staged as a case of FIGO stage IIIB. She received external beam-beam radiotherapy of 50 Gy in 25 fractions along with concurrent weekly cisplatin at 35 mg/m2 followed by 3 fractions of intracavitary brachytherapy of 6 Gy each. After 30 months of follow-up, she presented with a skin lesion of 6 × 5 cm2 in the infrascapular region for 2 months duration. Biopsy revealed metastatic squamous cell carcinoma. Her metastatic work-up revealed no other lesions. Palliative radiotherapy to local site of 8 Gy in single fraction was delivered. The lesion disappeared within 4 weeks. She was given 6 cycles of cisplatin and paclitaxel salvage chemotherapy. After 30 months of follow-up, she presented with a skin lesion of 6 × 5 cm2 in the infrascapular region. Biopsy revealed metastatic squamous cell carcinoma. Her metastatic work-up revealed no other lesions. Palliative radiotherapy to the local site was planned, and a dose of 8 Gy in a single fraction was delivered. The lesion disappeared within 4 weeks. She was given 6 cycles of cisplatin and paclitaxel salvage chemotherapy. Six months after the completion of salvage therapy, she reported with the complaints of recurrent bouts of hematemesis and melena. Her CECT scan revealed 2 × 1.5 cm2 growth in the body of the pancreas and a subcentric splenic hilum node. She underwent open splenectomy with distal pancreatectomy. Histopathology report showed metastatic infiltration in pancreatic tissue by squamous cell carcinoma and one metastatic node in the splenic hilum. Post-treatment, 6 months, the patient was asymptomatic with no recurrence. CONCLUSIONS This is a rare heterochronous metastatic presentation of cervical cancer without loco-regional recurrence and visceral organs such as the lung, liver, and brain. The optimal treatment remains undefined for these patients. Multimodality treatment is necessary to manage the patients.
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Affiliation(s)
- P K Gupta
- Department of Radiation Oncology, Super Speciality Cancer Institute and Hospital, C.G. City, Lucknow, Uttar Pradesh, 226002, India.
| | - P Lal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India
| | - A Tiwari
- Royal Cancer Institute and Research Centre, Kanpur, Uttar Pradesh, India
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Ioakim KJ, Sydney GI, Michaelides C, Sepsa A, Psarras K, Tsiotos GG, Salla C, Nikas IP. Evaluation of metastases to the pancreas with fine needle aspiration: A case series from a single centre with review of the literature. Cytopathology 2019; 31:96-105. [PMID: 31788890 DOI: 10.1111/cyt.12793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/25/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Fine needle aspiration (FNA) is a minimally invasive albeit highly effective modality used to detect solid and cystic pancreatic lesions. This manuscript aims to present our experience in diagnosing metastases to the pancreas and highlight the importance of immunocytochemistry in the diagnostic process. It also aims to provide a brief review of the literature on this topic. METHODS We retrospectively searched our archives for cases of metastatic deposits to the pancreas diagnosed with FNA over a 5-year period. We also reviewed the literature for such cases. RESULTS We describe seven cases from our archives that metastasised to the pancreas. Three of them (43%) represented metastatic renal cell carcinoma while the rest four comprised deposits from a lung adenocarcinoma, a colon adenocarcinoma, an adrenal leiomyosarcoma, and a small cell carcinoma of the urinary bladder, respectively. History of primary malignancy was available for all seven patients. All diagnoses were confirmed with the use of immunostains. In our literature review, similar to our case series, renal cell carcinoma was the most common metastasis to the pancreas managed with FNA (around one out of three patients; 35%). Of interest, our endoscopic ultrasound-FNA case of pancreatic metastasis from urinary bladder small cell carcinoma is the first reported. CONCLUSIONS As metastases to the pancreas are commonly accompanied by diverse prognostic signatures and management strategies compared to primary pancreatic malignancies, their accurate identification is imperative. Pancreatic FNA is a diagnostic modality that can confirm or exclude metastasis to the organ, especially when immunocytochemistry is applied.
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Affiliation(s)
| | - Guy I Sydney
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Constantinos Michaelides
- School of Medicine, European University Cyprus, Nicosia, Cyprus.,First Department of Pathology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasia Sepsa
- First Department of Pathology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Charitini Salla
- Department of Cytopathology, Hygeia & Mitera Hospital, Athens, Greece
| | - Ilias P Nikas
- School of Medicine, European University Cyprus, Nicosia, Cyprus
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Kim DJ, Park JM, Kim JH, Nam K, Kang CD, Lee SJ, Lee K, Jeon YH. Pancreatic Metastasis from Adenocarcinoma of the Uterine Cervix. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 73:182-185. [PMID: 31013562 DOI: 10.4166/kjg.2019.73.3.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/16/2018] [Accepted: 08/09/2018] [Indexed: 11/03/2022]
Abstract
Pancreatic metastasis from cervical cancer is extremely rare. We report a case of metastatic adenocarcinoma of the pancreas from uterine cervical cancer. A 70-year-old woman was referred because of a pancreatic mass detected by CT. She had been diagnosed with uterine cervical adenocarcinoma 20 months previously. After concurrent chemoradiotherapy, CT showed no evidence of the cervical mass, and follow-up showed no evidence of recurrence. Endoscopic ultrasound-guided fine needle aspiration biopsy of the pancreatic mass resulted in a diagnosis of metastatic adenocarcinoma from uterine cervix.
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Affiliation(s)
- Do Jun Kim
- Departments of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jin Myung Park
- Departments of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ji Hyun Kim
- Departments of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kilwoo Nam
- Departments of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Chang Don Kang
- Departments of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Sung Joon Lee
- Departments of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyoungyul Lee
- Department of Anatomic Pathology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Yong Hwan Jeon
- Department of Radiology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
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Lee EJ, Hwang J, Kim DW. Small-cell neuroendocrine carcinoma of the uterine cervix with pancreatic metastasis: a case report and a review of the literature. J OBSTET GYNAECOL 2019; 39:573-575. [DOI: 10.1080/01443615.2018.1534813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Eun Ji Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Dong Won Kim
- Department of Pathology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
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Kopke Túlio MACB, Horta MSF, Bispo MCS, Bana E Costa TSN, Chagas CMDBR. Pancreatic Metastases as the Initial Manifestation of a Neuroendocrine Carcinoma of the Uterine Cervix. Pancreas 2018; 47:e4-e5. [PMID: 29346219 DOI: 10.1097/mpa.0000000000000979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Maria Ana C B Kopke Túlio
- Department of Gastroenterology Centro Hospitalar Lisboa Ocidental Lisbon, Portugal Department of Radiology Centro Hospitalar Lisboa Ocidental Lisbon, Portugal Department of Gastroenterology Centro Hospitalar Lisboa Ocidental Lisbon, Portugal
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Uncommon Metastasis to the Pancreas From Adenocarcinoma of the Cervix Detected on Surveillance 18F-FDG PET/CT Imaging. Clin Nucl Med 2017; 42:e511-e512. [DOI: 10.1097/rlu.0000000000001849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Manuel V, Rocha E, Fortini G, Pascoal Z, Netto R, Rengel L, Birolini C, Utiyama EM. Uterine cancer presenting as obstructive jaundice. Int J Womens Health 2016; 8:261-3. [PMID: 27462179 PMCID: PMC4940018 DOI: 10.2147/ijwh.s108587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Obstructive jaundice as an initial manifestation of uterine cancer is extremely rare. We present a case of a 72-year-old female who presented with obstructive jaundice, supposedly for pancreatic cancer. After detailed diagnostic investigation, the cause of the jaundice was attributed to a metastatic compression of the common bile duct, from the primary neoplasm of the uterus. This case highlights the importance of including uterine cancer in the differential diagnosis of woman presenting with obstructive jaundice, even though it is very rare.
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Affiliation(s)
- Valdano Manuel
- Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Eserval Rocha
- Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Giovana Fortini
- Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Zeida Pascoal
- Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Renata Netto
- Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lenira Rengel
- Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Claudio Birolini
- Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Edivaldo Massazo Utiyama
- Department of General and Trauma Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil
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Smith AL, Odronic SI, Springer BS, Reynolds JP. Solid tumor metastases to the pancreas diagnosed by FNA: A single-institution experience and review of the literature. Cancer Cytopathol 2015; 123:347-55. [PMID: 25828394 DOI: 10.1002/cncy.21541] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/11/2015] [Accepted: 03/04/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pancreatic fine-needle aspiration (FNA) is useful for diagnosing pancreatic masses. This article describes the experience of a single institution with metastases to the pancreas sampled by FNA and provides a review of the literature. METHODS Medical records were retrospectively searched for pancreatic FNA that showed metastatic disease. Data were gathered for the tumor size, focality, and time period between the primary tumor and the metastasis. A literature search using PubMed was performed. RESULTS Pancreatic FNA was performed 2327 times in 14 years at the authors' institution. Twenty-two cases showed metastatic disease. The average size of the metastatic lesions in their greatest dimension was 3.7 cm (range, 1.5-6.5 cm). The majority of the tumors were unifocal (16 of 22 or 73%). A rapid onsite adequacy evaluation was performed for 13 patients (4 were diagnostic of metastasis, 3 were positive for malignant cells, 6 were atypical, and none were negative). There were 14 renal cell carcinomas, 2 colonic adenocarcinomas, 1 urothelial carcinoma, 1 non-small cell lung carcinoma, 1 ovarian serous carcinoma, 1 prostatic adenocarcinoma, 1 papillary thyroid carcinoma, and 1 mesenchymal chondrosarcoma. The median time between the diagnosis of the primary tumor and the initial pancreatic metastasis was 9 years (range, concurrent diagnosis to 21 years). A literature review yielded 12 case series with a variety of metastases to the pancreas diagnosed by FNA and surgical pathology specimens. CONCLUSIONS In agreement with prior series, the most common metastasis to the pancreas was renal cell carcinoma. A variety of other primary malignancies were also documented in this study and in the literature. Also, this article reports the first case of metastatic mesenchymal chondrosarcoma to the pancreas diagnosed by FNA.
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Affiliation(s)
- Amber L Smith
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shelley I Odronic
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Jordan P Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Nishimura C, Naoe H, Hashigo S, Tsutsumi H, Ishii S, Konoe T, Watanabe T, Shono T, Sakurai K, Takaishi K, Ikuta Y, Chikamoto A, Tanaka M, Iyama KI, Baba H, Katabuchi H, Sasaki Y. Pancreatic metastasis from mixed adenoneuroendocrine carcinoma of the uterine cervix: a case report. Case Rep Oncol 2013; 6:256-62. [PMID: 23741220 PMCID: PMC3670638 DOI: 10.1159/000351308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Metastatic cancers of the pancreas are rare, accounting for approximately 2-4% of all pancreatic malignancies. Renal cell carcinoma is the most common solid tumor that metastasizes to the pancreas. Here, we present a case of uterine cervical carcinoma metastasizing to the pancreas and review the literature regarding this rare event. A 44-year-old woman with a uterine cervical tumor had undergone radical hysterectomy and had been diagnosed pathologically with stage Ib mixed adenoneuroendocrine carcinoma in 2004. She underwent concurrent radiotherapy and chemotherapy postoperatively. Pulmonary metastases subsequently appeared in 2008 and 2011, and she underwent complete resection of the lung tumors by video-assisted thoracic surgery. Although she was followed up without any treatment and with no other recurrences, positron emission tomography revealed an area of abnormal uptake within the pancreatic body in 2012. Enhanced computed tomography demonstrated a 20-mm lesion in the pancreatic body and upstream pancreatic duct dilatation. Endoscopic ultrasonography-guided fine needle aspiration was performed and pathological examination suggested neuroendocrine carcinoma (NEC). On the basis of these results and the patient's oncological background, lesions in the pancreatic body were diagnosed as secondary metastasis from the cervical carcinoma that had been treated 8 years earlier. No other distant metastases were visualized, and the patient subsequently underwent middle pancreatectomy. Pathological examination showed NEC consistent with pancreatic metastasis from the uterine cervical carcinoma. The patient has survived 7 months since the middle pancreatectomy without any signs of local recurrence or other metastatic lesions.
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Affiliation(s)
- Chihiro Nishimura
- Departments of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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