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Scarpa-Carniello JV, Siddiqui MT. Challenges and Pitfalls in Pancreatobiliary Cytopathology. Acta Cytol 2024; 68:219-226. [PMID: 38631319 DOI: 10.1159/000538687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/30/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION The advances of minimally invasive endoscopy-guided procedures that usually yield limited diagnostic material changed pancreaticobiliary cytopathology into one of the most challenging areas of cytopathology given the abundance of differential diagnoses to be considered when dealing with limited specimens. CASE PRESENTATION We describe a few challenging examples of potential pitfalls in pancreatobiliary cytopathology evaluation collected from a busy academic hospital (tertiary) center. Case 1 illustrates the challenges in handling paucicellular specimens from pancreatic solid lesions in which differential diagnoses may include acinar cell carcinoma, neuroendocrine tumors, adenocarcinoma, or even benign pancreatic tissue, among others. Case 2 illustrates the pitfalls in evaluating limited specimens from patients with chronic pancreatitis, specially when distinguishing exuberant reactive atypia from dysplastic changes is mandatory. Case 3 illustrates pitfalls in distinguishing malignancy from reactive changes in biliary brushing specimens from patients with primary sclerosing cholangitis. Finally, cases 4 and 5 highlight the importance of including the possibility of pancreatic metastasis in the differential diagnoses of some pancreatic lesions. CONCLUSION Over time, there has been an increasing demand for pathologists to render diagnoses on limited specimens obtained through minimally invasive procedures which can be frequently challenging even for the most experienced professionals. In many difficult cases, salvaging additional material for a cell block can turn out to be extremely helpful given the possibility of utilizing additional ancillary tests for diagnostic confirmation.
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Affiliation(s)
- Jose Victor Scarpa-Carniello
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York, USA
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2
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Bishnoi K, Agrawal K, Mishra SK, Purkait S. Uncommon Site of Metastasis: A Case Report of Breast Carcinoma Spreading to the Pancreas. Indian J Nucl Med 2024; 39:120-122. [PMID: 38989314 PMCID: PMC11232732 DOI: 10.4103/ijnm.ijnm_45_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/08/2023] [Accepted: 05/29/2023] [Indexed: 07/12/2024] Open
Abstract
The metastatic lesions to pancreas are reported in various malignancies. However, pancreatic metastasis from breast cancer is rare and difficult to diagnose due to nonspecific symptoms and imaging findings. At the time of diagnosis, there may already be an associated widespread metastasis. In this case report, a woman in her forties with a history of breast cancer was found to have widespread metastases, including in the pancreas. The patient was treated with chemotherapy and hormonal therapy.
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Affiliation(s)
- Komal Bishnoi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sourav Kumar Mishra
- Department of Medical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suvendu Purkait
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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3
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Denda Y, Matsuo Y, Nonoyama K, Murase H, Kato T, Hayashi Y, Imafuji H, Saito K, Morimoto M, Kato H, Yoshida M, Naitoh I, Hayashi K, Ogawa R, Takahashi H, Takiguchi S. Simultaneous presentation and resection of esophageal cancer and metastasis to the pancreas: Α case report and literature review. Mol Clin Oncol 2024; 20:2. [PMID: 38223405 PMCID: PMC10784768 DOI: 10.3892/mco.2023.2700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/02/2023] [Indexed: 01/16/2024] Open
Abstract
The frequency of metastasis to the pancreas is limited, and the frequency of metastasis of a squamous cell carcinoma of the esophagus is limited even further. The curative resection of this type of metastatic lesion has been reported for some patients; however, the survival benefit that can be attributed to these procedures has not yet been clearly determined. The patient examined in the present study was a 54-year-old man who was diagnosed with a lower thoracic esophageal cancer. Computed tomography revealed a 2-cm tumor at the tail of the pancreas. Since no other obvious distal metastases were observed, the patient underwent simultaneous surgical procedures, excising the esophageal squamous cell carcinoma and the pancreatic metastasis. A histopathological examination confirmed squamous cell carcinoma in both specimens. The patient has been free of disease for 9 months since the resection. A literature review of all relevant cases to date also demonstrated that the primary tumor site in all cases of patients with esophageal cancer presenting with metastasis to the pancreas was the lower thoracic esophagus. Complete simultaneous resections of esophageal squamous cell carcinoma and a solitary metastasis to the pancreas is beneficial and may produce favorable outcomes. However, due to the reduced number of corresponding reports, further studies are required for the confirmation of the benefits of surgery.
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Affiliation(s)
- Yuki Denda
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Keisuke Nonoyama
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Hiromichi Murase
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Tomokatsu Kato
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Yuichi Hayashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Hiroyuki Imafuji
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Kenta Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Mamoru Morimoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Hiroyuki Kato
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Michihiro Yoshida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Kazuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
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4
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Sellner F, Compérat E, Klimpfinger M. Genetic and Epigenetic Characteristics in Isolated Pancreatic Metastases of Clear-Cell Renal Cell Carcinoma. Int J Mol Sci 2023; 24:16292. [PMID: 38003482 PMCID: PMC10671160 DOI: 10.3390/ijms242216292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Isolated pancreatic metastases of renal cell carcinoma (IsPMRCC) are a rare manifestation of metastatic, clear-cell renal cell carcinoma (RCC) in which distant metastases occur exclusively in the pancreas. In addition to the main symptom of the isolated occurrence of pancreatic metastases, the entity surprises with additional clinical peculiarities: (a) the unusually long interval of about 9 years between the primary RCC and the onset of pancreatic metastases; (b) multiple pancreatic metastases occurring in 36% of cases; (c) favourable treatment outcomes with a 75% 5-year survival rate; and (d) volume and growth-rate dependent risk factors generally accepted to be relevant for overall survival in metastatic surgery are insignificant in isPMRCC. The genetic and epigenetic causes of exclusive pancreatic involvement have not yet been investigated and are currently unknown. Conversely, according to the few available data in the literature, the following genetic and epigenetic peculiarities can already be identified as the cause of the protracted course: 1. high genetic stability of the tumour cell clones in both the primary tumour and the pancreatic metastases; 2. a low frequency of copy number variants associated with aggressiveness, such as 9p, 14q and 4q loss; 3. in the chromatin-modifying genes, a decreased rate of PAB1 (3%) and an increased rate of PBRM1 (77%) defects are seen, a profile associated with a favourable course; 4. an increased incidence of KDM5C mutations, which, in common with increased PBRM1 alterations, is also associated with a favourable outcome; and 5. angiogenetic biomarkers are increased in tumour tissue, while inflammatory biomarkers are decreased, which explains the good response to TKI therapy and lack of sensitivity to IT.
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Affiliation(s)
- Franz Sellner
- Department of General, Visceral and Vascular Surgery, Clinic Favoriten Vienna, Kaiser Franz Josef Hospital, 1100 Vienna, Austria
| | - Eva Compérat
- Clinical Institute of Pathology, Medical University Vienna, 1090 Vienna, Austria
| | - Martin Klimpfinger
- Clinical Institute of Pathology, Medical University Vienna, 1090 Vienna, Austria
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5
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Spadaccini M, Conti Bellocchi MC, Mangiavillano B, Fantin A, Rahal D, Manfrin E, Gavazzi F, Bozzarelli S, Crinò SF, Terrin M, Di Leo M, Bonifacio C, Facciorusso A, Realdon S, Cristofori C, Auriemma F, Fugazza A, Frulloni L, Hassan C, Repici A, Carrara S. Secondary Tumors of the Pancreas: A Multicenter Analysis of Clinicopathological and Endosonographic Features. J Clin Med 2023; 12:jcm12082829. [PMID: 37109171 PMCID: PMC10145689 DOI: 10.3390/jcm12082829] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/17/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Many tumors may secondarily involve the pancreas; however, only retrospective autopic and surgical series are available. We retrospectively collected data from all consecutive patients with histologically confirmed secondary tumors of the pancreas referred to five Italian centers between 2010 and 2021. We described clinical and pathological features, therapeutic approach and treatment outcomes. EUS characteristics of the lesions and the tissue acquisition procedures (needle, passages, histology) were recorded. A total of 116 patients (males/females 69/47; mean age 66.7) with 236 histologically confirmed pancreatic metastases were included; kidney was the most common primary site. EUS was performed to confirm the diagnosis in 205 lesions which presented as predominantly solitary (59), hypoechoic (95) and hypervascular (60), with a heterogeneous (n = 54) pattern and well-defined borders (n = 52). EUS-guided tissue acquisition was performed in 94 patients with an overall accuracy of 97.9%. Histological evaluation was possible in 88.3% of patients, obtaining final diagnosis in all cases. When cytology alone was performed, the final diagnosis was obtained in 83.3% of cases. A total of 67 patients underwent chemo/radiation therapy, and surgery was attempted in 45 (38.8%) patients. Pancreatic metastases are a possible event in the natural history of solid tumors, even long after the diagnosis of the primary site. EUS-guided fine needle biopsy may be suggested to implement the differential diagnosis.
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Affiliation(s)
- Marco Spadaccini
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Milan, Italy
| | - Maria Cristina Conti Bellocchi
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy
| | - Benedetto Mangiavillano
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Alberto Fantin
- Gastroenterology Unit, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - Daoud Rahal
- Department of Pathology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Erminia Manfrin
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy
| | - Francesca Gavazzi
- Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Silvia Bozzarelli
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Stefano Francesco Crinò
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy
| | - Maria Terrin
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Milan, Italy
| | - Milena Di Leo
- Digestive Endoscopy Unit, Division of Gastroenterology, San Paolo Hospital, 20090 Milan, Italy
| | - Cristiana Bonifacio
- Department of Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Stefano Realdon
- Gastroenterology Unit, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - Chiara Cristofori
- Gastroenterology Unit, Istituto Oncologico Veneto IOV-IRCCS, 35128 Padova, Italy
| | - Francesco Auriemma
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Mater Domini, 21053 Castellanza, Italy
| | - Alessandro Fugazza
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Luca Frulloni
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy
| | - Cesare Hassan
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Milan, Italy
| | - Alessandro Repici
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089 Milan, Italy
| | - Silvia Carrara
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
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6
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Kinoshita S, Yamashita YI, Kitano Y, Hayashi H, Sugimachi K, Nishizaki T, Fukuzawa K, Kajiyama K, Miyanari N, Yoshizumi T, Takamori H, Baba H. Survival impact of pancreatic resection for metastases in the pancreas: A retrospective multi-center study. Surg Oncol 2023; 48:101942. [PMID: 37043926 DOI: 10.1016/j.suronc.2023.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Pancreatic metastases from other primary malignancies are rare. There is no clear evidence for a treatment strategy for this condition. The purpose of this study was to assess the clinical outcomes, including prognostic factors for pancreatic resection of metastatic tumors in the pancreas, through a retrospective review. METHODS Data of 35 patients who underwent pancreatic resection for pancreatic metastasis between 2005 and 2020 in eight Japanese institutions were included in this study. Survival analyses were performed using the Kaplan-Meier method, and comparisons were made using the Cox proportional hazards model. RESULTS The median follow-up period was 35 months (range, 5-102 months). Median duration from resection for primary tumor to resection for metastatic pancreatic tumor was 10.6 years (range, 0.6-29.2 years). The 3- and 5-year survival rates after resection for metastatic tumors in the pancreas were 89% and 69%, respectively. In contrast, the 3- and 5-year disease-free survival rates after resection for metastatic tumors in the pancreas were 48% and 21%, respectively. Performance status ≥1 at the time of resection for metastatic tumors in the pancreas (HR: 7.56, p = 0.036) and pancreatic metastasis tumor diameter >42 mm (HR: 6.39, p = 0.02) were significant poor prognostic factors only in the overall survival. CONCLUSIONS The prognosis of pancreatic resection for metastatic tumors in the pancreas is relatively good for selected patients. However, because it is prone to recurrence after radical surgery, it should only be considered in patients with good PS.
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7
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Sellner F, Thalhammer S, Klimpfinger M. Isolated Pancreatic Metastases of Renal Cell Carcinoma-Clinical Particularities and Seed and Soil Hypothesis. Cancers (Basel) 2023; 15:cancers15020339. [PMID: 36672289 PMCID: PMC9857376 DOI: 10.3390/cancers15020339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023] Open
Abstract
A meta-analysis of 1470 isolated pancreatic metastases of renal cell carcinoma revealed, that, in addition to the unusual exclusive occurrence of pancreatic metastases and the favourable treatment results, the isPMRCC is characterised by further peculiarities of the clinical course: The lack of prognostic significance of volume and growth rate dependent risk factors and the independence of treatment results from standard or local resections. As an explanation for all these peculiarities, according to today's knowledge, a strong acting seed and soil mechanism can serve, which allows embolized tumour cells to grow to metastases only in the pancreas, and prevents them definitively or for years in all other organs. The good prognosis affects not only isolated PM, but also multi-organ metastases of the RCC, in which the additional occurrence of PM is also associated with a better prognosis. Genetic studies revealed specific changes in cases of PM of RCC: Lack of loss of 9p21.3 and 14q31.2, which are otherwise specific gene mutations at the onset of generalization, a low weight genome instability index, i.e., high genetic stability, and a low rate of PAB1 and a high rate of BPRM1 alterations, which signal a more favourable course. The cause of pancreatic organotropism in isPMRCC is still unclear, so only those factors that have been identified as promoting organotropism in other, more frequent tumour entities can be presented: Formation of the pre-metastatic niche, chemokine receptor-ligand mechanism, ability to metabolic adaptation, and immune surveillance.
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Affiliation(s)
- Franz Sellner
- Department of General, Visceral and Vascular Surgery, Clinic Favoriten, Kaiser Franz Josef Hospital, 1100 Vienna, Austria
- Correspondence:
| | - Sabine Thalhammer
- Department of General, Visceral and Vascular Surgery, Clinic Favoriten, Kaiser Franz Josef Hospital, 1100 Vienna, Austria
| | - Martin Klimpfinger
- Clinical Institute of Pathology, Medical University, 1090 Vienna, Austria
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8
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Retroperitoneal liposarcoma with pancreatic metastasis and gastric cancer: a case report. Clin J Gastroenterol 2022; 16:164-170. [PMID: 36534319 DOI: 10.1007/s12328-022-01742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
On computed tomography scanning, a 63-year-old man with vomiting and anorexia was discovered to have a mass in the pancreatic body and a retroperitoneal mass extending to the right lobe of the liver. An esophagogastroduodenoscopy revealed an advanced gastric carcinoma in the middle gastric body, and a biopsy specimen revealed a poorly differentiated adenocarcinoma. The pancreatic and retroperitoneal masses were considered metastatic lesions of gastric cancer, and a biopsy was taken from the pancreatic lesion using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). The histology of the EUS-FNA pancreatic specimen revealed atypical spindle-shaped cells and increased stromal collagen fibrosis, and liposarcoma was considered. Conversely, a percutaneous ultrasound-guided biopsy was taken for the retroperitoneal lesion, and the histology revealed that it was a dedifferentiated liposarcoma. On the basis of histopathological and imaging findings, the retroperitoneal liposarcoma was identified as the primary lesion, the pancreatic lesion as a metastasis of the primary liposarcoma, and the gastric carcinoma as an independent tumor. As far as we know, there have only been three reports of metastatic pancreatic liposarcoma diagnosed via EUS-FNA. In this case, the patient also had gastric cancer, and EUS-FNA was helpful in differentiating metastatic pancreatic tumors from gastric cancer.
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Bachellier P, Addeo P, Averous G, Dufour P. Resection of pancreatic adenocarcinomas with synchronous liver metastases: A retrospective study of prognostic factors for survival. Surgery 2022; 172:1245-1250. [PMID: 35422325 DOI: 10.1016/j.surg.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to evaluate the results of synchronous liver resection for metastatic pancreatic ductal adenocarcinomas and to identify prognostic factors for overall survival. METHODS We retrospectively reviewed clinical data from patients who underwent the synchronous resection of pancreatic adenocarcinoma with liver metastases. Cox analyses were used to identify factors prognostic of overall survival. RESULTS Of the 92 patients included in this study, preoperative chemotherapy was administered to 52 patients. The median overall survival was 18.26 months (95% confidence interval: 14.7-22.7) (from diagnosis) and 12.68 months (95% confidence interval: 9.5-15.57) from surgery; overall survival at 1, 3, and 5 years was 70%, 10%, and 0%, respectively. Twenty-eight patients (30.4%) had median overall survival >18 months after surgery. The median overall survival from diagnosis was longer in patients undergoing preoperative treatment (22.7 vs 13.8 months; P = .01) but similar after surgery (12.6 vs 13.8 months; P = .86). Multivariate Cox analysis found CA19-9 levels <500 kU/L (hazard ratio: 0.35; 95% confidence interval: 0.17-0.70; P = .003), R0 resection (hazard ratio: 0.46; 95% confidence interval: 0.24-0.88; P = .020), and adjuvant chemotherapy (hazard ratio: 0.39; 95% confidence interval: 0.17-0.88; P = .024) as independent prognostic factors for overall survival. CONCLUSION Survival after resection of oligometastatic liver disease remains limited, reflecting the dismal prognosis of metastatic disease even after aggressive treatment. Preresection CA19-9 serum levels represent a useful tool for patient selection, and administration of adjuvant chemotherapy has a major impact on overall survival. Large comparative studies with exclusive chemotherapy are needed to validate this approach and to identify optimal candidates.
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Affiliation(s)
- Philippe Bachellier
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Pietro Addeo
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France.
| | - Gerlinde Averous
- Department of Pathology, University of Strasbourg, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Patrick Dufour
- Department of Oncology, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
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10
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The role of hepatic and pancreatic metastatectomy in the management of metastatic renal cell carcinoma: A systematic review. Surg Oncol 2022; 44:101819. [DOI: 10.1016/j.suronc.2022.101819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 07/04/2022] [Accepted: 07/11/2022] [Indexed: 12/09/2022]
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11
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Koyuncuer A, Sayar S, Zemheri IE, Özdil K, Özçelik M. An exceptionally rare case of metastatic high-grade urothelial carcinoma of the renal pelvis to the pancreas diagnosed on endoscopic ultrasound-guided fine-needle aspiration: A diagnostic challenge. Diagn Cytopathol 2022; 50:E295-E300. [PMID: 35656642 DOI: 10.1002/dc.24998] [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: 04/19/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/08/2022]
Abstract
Metastases to the pancreas are rare and can be confused with the primary adenocarcinoma of the pancreas. Metastasis of renal pelvis urothelial carcinomas to the pancreas are extremely rare. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy is a very safe and effective diagnostic method. In this study, we present a 65-year-old male patient with a solitary mass in the pancreas. A moderate cellular tumoral lesion was observed in the aspiration cytology performed from the 55-millimeter solid mass invading the head of the pancreas via EUS-FNA. Tumor cells consisted of cells with irregular borders, different shapes and sizes, hyperchromatic, narrow cytoplasm with dark nuclei, and cells with anisonucleosis in focal areas. Cellblock obtained from aspirated was found diffusely positive with high molecular weight cytokeratin, Thrombomodulin, p63, GATA-3, and CK7, and negative with CK20, PAX8, and PSA. Having a primary malignancy in the medical history of the patients is very important in the differential diagnosis of primary and secondary pancreatic cancers. The potential for metastasectomy in pancreatic metastases can be applied in cases with isolated metastatic disease. Primary tumor histopathology may have an impact on the long-term survival of the case. This study aimed to describe the cytomorphological features of solid and solitary pancreatic malignancies and to evaluate the role of immunohistochemistry performed from aspirate cell block in detecting the primary tumor origin.
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Affiliation(s)
- Ali Koyuncuer
- Department of Pathology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Süleyman Sayar
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Itır Ebru Zemheri
- Department of Pathology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kamil Özdil
- Department of Gastroenterology, Health Sciences University, Umraniye Training and Research Hospital, İstanbul, Turkey
| | - Melike Özçelik
- Department of Medical Oncology, Health Sciences University, Umraniye Training and Research Hospital, İstanbul, Turkey
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12
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Isolated Pancreatic Metastases of Renal Cell Cancer: Genetics and Epigenetics of an Unusual Tumour Entity. Cancers (Basel) 2022; 14:cancers14061539. [PMID: 35326690 PMCID: PMC8945920 DOI: 10.3390/cancers14061539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 12/16/2022] Open
Abstract
Isolated pancreatic metastases of renal cell carcinoma (isPMRCC) are a rare manifestation of metastatic renal cell carcinoma (mRCC) characterized by two peculiarities: (1). The definite or at least long-term exclusive occurrence of metastases in the pancreas and (2). an unusual low tumour aggressiveness with slow tumour progression and consecutive, good treatment results. According to current knowledge, the exclusive occurrence of pancreatic metastases is due to a highly specific and highly selective seed and soil mechanism, which does not allow metastases settlement outside the pancreas, and whose detailed genetic/epigenetic causes are not yet elucidated. Recent studies have shed light on some of the pathways involved for the protracted course of the disease and highlighted a special genetic profile (lack of loss of 9p, lower weight genome instability index, low frequency of BAP1 alterations, and a high frequency of PBRM1 loss), which deviates from the conventional mRCC profile. Finally, the question of the reasons for the long-term relative genetic stability of the involved cell clones, which is an essential prerequisite for a favourable prognosis, remains unanswered.
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13
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Okamoto T. Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer. World J Gastroenterol 2022; 28:985-1008. [PMID: 35431494 PMCID: PMC8968522 DOI: 10.3748/wjg.v28.i10.985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/03/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku 104-8560, Tokyo, Japan
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14
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Novotny A, Sell E, Mehrotra S. Metastatic tumors to the pancreas, a 12-year single institution review. Diagn Cytopathol 2021; 49:1233-1236. [PMID: 34699133 DOI: 10.1002/dc.24865] [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: 06/25/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tumors of the pancreas are often primary in nature, but are occasionally proven to be secondary. We report a 12-year review of all pancreatic tumors shown to be metastatic at the University of Colorado. METHOD The electronic pathology database was searched between 2008 and 2020, for all pancreatic fine-needle aspiration cases at the University of Colorado to identify and review metastatic tumors to the pancreas. Additional data points to include age, sex, radiographic features, and clinical management were analyzed. RESULTS Our data retrieval identified 39 metastatic tumors to the pancreas comprised of 12 (31%) renal cell carcinomas, 6 (15%) lung carcinomas, and 5 (13%) melanomas with the remainder of tumors originating from a variety of other sites. The most common location of these metastases within the pancreas was the pancreatic head (49%) followed by the body (20%). Eighty-five percentage of cases presented with a single radiographically identified mass. CONCLUSION While the majority of pancreatic tumors represent primary processes, metastatic tumors to the pancreas represent a possible pitfall. The most common tumors to metastasize to the pancreas in this series were renal cell carcinoma, lung carcinoma, and melanoma. General awareness of the most frequent tumors to metastasize to the pancreas is practical when faced with a pancreatic lesion that could represent a metastasis, or in the absence of clinical history.
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Affiliation(s)
- Aaron Novotny
- Department of Pathology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Evan Sell
- Forward Pathology Solutions, Denver, Colorado, USA
| | - Sanjana Mehrotra
- Department of Pathology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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15
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Kataoka K, Ishikawa T, Ohno E, Mizutani Y, Iida T, Ishikawa E, Furukawa K, Nakamura M, Honda T, Ishigami M, Kawashima H, Hirooka Y, Fujishiro M. Differentiation between pancreatic metastases from renal cell carcinoma and pancreatic neuroendocrine neoplasm using endoscopic ultrasound. Pancreatology 2021; 21:1364-1370. [PMID: 34281790 DOI: 10.1016/j.pan.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Pancreatic metastases from renal cell carcinoma (PRCC) often appear many years after treatment of the primary tumor, and differentiation from pancreatic neuroendocrine neoplasm (PanNEN) can be challenging due to their hypervascularity. Here, we investigated the utility of endoscopic ultrasound (EUS) for differentiation of these conditions. METHODS A retrospective analysis was performed in 17 and 79 consecutive patients with pathologically proven PRCC and non-functional PanNEN who were examined by EUS. In cases examined by EUS elastography or contrast-enhanced harmonic EUS (CH-EUS), the lesions were classified as stiff or soft, or into three vascular patterns as hypoechoic, isoechoic, and hyperechoic. CH-EUS images at 20 s, 40 s, 60 s, 3 min and 5 min were used for evaluation. EUS images were independently reviewed by two readers who were blinded to all clinical information. RESULTS The patients with PRCC were significantly older than those with PanNEN (median, 71 (range, 45-81) vs. 58 (22-76), P = 0.001) and more often had multiple tumors (6/17 (35%) vs. 7/79 (9%), P = 0.010). In EUS findings, PRCC lesions significantly more frequently had a marginal hypoechoic zone (MHZ) (11/17 (65%) vs. 27/79 (34%), P = 0.028), being classified as soft (12/13 (92%) vs. 26/58 (45%), P = 0.002), and showed sustained hyperechoic vascular patterns at 5 min (7/8 (88%) vs. 4/59 (7%), P < 0.001) compared to PanNEN lesions. CONCLUSIONS The presence of a MHZ, a soft lesion, and a sustained hyperechoic vascular pattern in EUS may be useful for differentiating PRCC from PanNEN.
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Affiliation(s)
- Kunio Kataoka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan.
| | - Yoshiki Hirooka
- Department of Gastroenterology and Gastroenterological Oncology, Fujita Health University, Toyoake, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Malleo G, Salvia R, Maggino L, Marchegiani G, D'Angelica M, DeMatteo R, Kingham P, Pulvirenti A, Sereni E, Jarnagin WR, Bassi C, Allen PJ, Butturini G. Long-term Outcomes After Surgical Resection of Pancreatic Metastases from Renal Clear-Cell Carcinoma. Ann Surg Oncol 2021; 28:3100-3108. [PMID: 33575870 PMCID: PMC8119267 DOI: 10.1245/s10434-021-09649-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pancreatic metastases (PM) from renal cell carcinoma (RCC) are uncommon. We herein describe the long-term outcomes associated with pancreatectomy at two academic institutions, with a specific focus on 10-year survival. METHODS This investigation was limited to patients undergoing pancreatectomy for PM between 2000 and 2008 at the University of Verona and Memorial Sloan Kettering Cancer Center, allowing a potential for 10 years of surveillance. The probabilities of further RCC recurrence and RCC-related death were estimated using a competing risk analysis (method of Fine and Gray) to account for patients who died of other causes during follow-up. RESULTS The study population consisted of 69 patients, mostly with isolated metachronous PM (77%). The median interval from nephrectomy to pancreatic metastasectomy was 109 months, whereas the median post-pancreatectomy follow-up was 141 months. The 10-year cumulative incidence of new RCC recurrence was 62.7%. In the adjusted analysis, the relative risk of repeated recurrence was significantly higher in PM synchronous to the primary RCC (sHR = 1.27) and in patients receiving extended pancreatectomy (sHR = 3.05). The 10-year cumulative incidence of disease-specific death was 25.5%. The only variable with an influence on disease-specific death was the recurrence-free interval following metastasectomy (sHR = 0.98). In patients with repeated recurrence, the 10-year cumulative incidence of RCC-related death was 35.4%. CONCLUSION In a selected group of patients followed for a median of 141 months and mostly with isolated metachronous PM, resection was associated with a high possibility of long-term disease control in surgically fit patients with metastases confined to the pancreas.
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Affiliation(s)
- Giuseppe Malleo
- Unit of General and Pancreatic Surgery-DSCOMI University of Verona, Verona, Italy.
| | - Roberto Salvia
- Unit of General and Pancreatic Surgery-DSCOMI University of Verona, Verona, Italy
| | - Laura Maggino
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Giovanni Marchegiani
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Michael D'Angelica
- The Hepato-Biliary and Pancreatic Unit, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald DeMatteo
- The Hepato-Biliary and Pancreatic Unit, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter Kingham
- The Hepato-Biliary and Pancreatic Unit, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alessandra Pulvirenti
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
- The Hepato-Biliary and Pancreatic Unit, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elisabetta Sereni
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - William R Jarnagin
- The Hepato-Biliary and Pancreatic Unit, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Claudio Bassi
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
| | - Peter J Allen
- The Hepato-Biliary and Pancreatic Unit, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Surgery, Duke University, Durham, NC, USA
| | - Giovanni Butturini
- Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, University of Verona Hospital Trust, Verona, Italy
- Unit of Pancreatic Surgery, Pederzoli Hospital, Peschiera del Garda, Italy
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17
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Zhang L, Long X, Hu ZN, Wu Y, Song J, Zhang BX, Chen WX. An extremely atypical presentation of esophageal squamous cell carcinoma with pancreatic and hepatic metastases: A case report and overview of the literature. Medicine (Baltimore) 2021; 100:e25785. [PMID: 34011038 PMCID: PMC8137018 DOI: 10.1097/md.0000000000025785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Esophageal carcinoma is an aggressive cancer with extremely poor therapeutic outcomes due to its high metastatic potential and a significant risk of recurrence after radical resection. Liver is the most common metastatic target organ of esophageal carcinoma, followed by the lungs, bones, and brain. Few cases of solitary pancreatic and hepatic metastases of esophageal carcinoma have been reported. PATIENT CONCERNS We report the case of a 67-year-old male presenting with pancreatic and hepatic lesions. In addition, a friable lesion with an irregular nodular surface in the distal esophagus was detected by esophagogastroduodenoscopy. DIAGNOSIS Pathohistological examination confirmed esophageal squamous cell carcinoma. The pancreatic lesion was also biopsied via ultrasound-guided fine needle aspiration, which also revealed squamous cell carcinoma. The hepatic lesion was also identified as metastatic carcinoma by magnetic resonance imaging, most likely of the same origin. INTERVENTIONS Due to comorbidities that precluded surgery, the patient was administered adjuvant therapy and a multidisciplinary decision was made for palliative care. OUTCOMES The patient died 1 month later due to multiorgan failure caused by hemorrhage from a peptic ulcer. CONCLUSION To our knowledge, this is only the sixth case of pancreatic metastasis of esophageal squamous cell carcinoma. This case report suggests to clinicians the importance of considering potential comorbidities in every patient with advanced cancer, such as gastric ulcer and cachexia.
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18
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Ng TG, Damiris K, Trivedi U, George JC. Obstructive jaundice, a rare presentation of lung cancer: A case report. Respir Med Case Rep 2021; 33:101425. [PMID: 34401271 PMCID: PMC8348151 DOI: 10.1016/j.rmcr.2021.101425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/20/2021] [Accepted: 05/07/2021] [Indexed: 10/29/2022] Open
Abstract
Lung cancer metastases to the pancreas are rare but potentially life-threatening. Oftentimes, the presence of symptoms is indicative of extensive disease burden. This report describes a case of primary lung adenocarcinoma metastasizing to the head of the pancreas presenting as obstructive jaundice. The patient was a 61-year-old female veteran who presented with a chronic dyspnea, weight loss, and 3-weeks of nausea and vomiting found to have jaundice, elevated alkaline phosphatase levels, hyperbilirubinemia, and transaminitis. Imaging of her chest revealed large pulmonary parenchymal nodules throughout both lungs with a large left lower lobe mass and consolidation. Abdominal imaging showed a large heterogeneous mass in the pancreatic head, a grossly dilated common bile duct, and enlarged retroperitoneal lymph nodes contiguous with the mass. Pancreatic head biopsies revealed metastatic cancer cells from her lung adenocarcinoma which was confirmed via cytology and the presence of thyroid transcription factor - 1 and cytokeritin-7 expression and the absence of tumor protein 63 staining. Lung adenocarcinomas commonly metastasize to the bones, liver, and central nervous system but very rarely to the pancreas. There have been only a few reported cases of pancreatic tumors that manifested clinically as a result of primary lung cancer metastases however, even though uncommon, hematogenous spread of cancerous tissue should be considered on the differential as a cause for obstructive jaundice in the setting of lung adenocarcinoma.
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Affiliation(s)
- Thomas G Ng
- Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ, 07012, USA
| | | | - Usha Trivedi
- Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ, 07012, USA
| | - Jason C George
- VA New Jersey Healthcare System East Orange Campus, 385 Tremont Avenues, East Orange, NJ, 07018, USA
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19
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Hirashita T, Iwashita Y, Endo Y, Fujinaga A, Shin T, Mimata H, Inomata M. How Should We Treat Pancreatic Metastases from Renal Cell Carcinoma? A Meta-Analysis. World J Surg 2021; 45:2191-2199. [PMID: 33768307 DOI: 10.1007/s00268-021-06071-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The treatment strategy for pancreatic metastasis (PM) from renal cell carcinoma (RCC) is unclear due to its rarity. The aim of this study was to reveal the role of surgery for PM from RCC. METHODS A systematic literature search was conducted using PubMed and the Cochrane Library. The effectiveness of surgery for PM was evaluated based on the primary outcome of overall survival (OS), which was investigated in relation to surgical procedures and metastatic sites via subgroup analyses. RESULTS There was no significant difference in the rate of 2-year OS between the surgery and control group (OR 0.43, 95% CI 0.14-1.26, P = 0.12). However, the rate of 5-year OS was significantly higher in the surgery group than the control group (OR = 0.41, 95% CI 0.18-0.93, P = 0.03). The rates of the complications and OS were not significantly different between radical and conservative pancreatectomies. The rate of 5-year OS of the patients with PM was higher than that with other metastases (OR 0.38, 95% CI 0.20-0.74, P = 0.004). CONCLUSION Surgical resection for PM from RCC is associated with good prognosis. Limited surgery may be a useful option depending on the location of the lesion.
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Affiliation(s)
- Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Toshitaka Shin
- Department of Urology, Faculty of Medicine, Oita University, 1-1 Hasama-machi, Yufu , Oita, 879-5593, Japan
| | - Hiromitsu Mimata
- Department of Urology, Faculty of Medicine, Oita University, 1-1 Hasama-machi, Yufu , Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
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20
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Sellner F, Thalhammer S, Klimpfinger M. Tumour Evolution and Seed and Soil Mechanism in Pancreatic Metastases of Renal Cell Carcinoma. Cancers (Basel) 2021; 13:1342. [PMID: 33809634 PMCID: PMC8002056 DOI: 10.3390/cancers13061342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/06/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023] Open
Abstract
In metastatic renal cell carcinoma, pancreatic metastases can appear in two clinical manifestations: (a) very rarely as isolated pancreatic metastases and (b) in the context with multi-organ metastatic disease. Both courses are characterised by rare, unusual clinical features. For isolated pancreatic metastases, the literature shows no effect on survival in all 11 publications that examined the effect of singular versus multiple pancreatic metastases; a lack of effect on survival time was also present in all 8 studies on pancreatic metastases size, in 7 of 8 studies on the influence of disease-free interval (DFI), and in 6 of 7 studies on the influence of synchronous versus metachronous metastases. In multi-organ site metastases observations, on the other hand, all five available references showed significantly better results in patients with concurrent pancreatic metastases compared to those without pancreatic metastases, although the total number of affected organs in the pancreatic metastases cohort was larger. Tumour volume-dependent risk factors thus remain surprisingly ineffective in both groups, which contradicts the usual behaviour of solid tumours. The reasons for this unusual behaviour and possible relations to tumour evolution and the hypothesis of an influence of a seed and soil mechanism in the occurrence of pancreatic metastases in metastatic renal cell carcinoma are discussed.
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Affiliation(s)
- Franz Sellner
- Department of Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabine Thalhammer
- Department of General-, Visceral- and Vascular Surgery, Clinic Favoriten—Kaiser Franz Josef Hospital, 1100 Vienna, Austria;
| | - Martin Klimpfinger
- Clinical Institute of Pathology, Medical University, 1090 Vienna, Austria;
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21
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Piskorz Ł, Mitura K, Olejniczak W, Misiak P, Jablonski S. Atypical Locations of Renal Cell Carcinoma Metastases to the Pancreas and Duodenum. Res Rep Urol 2021; 13:17-24. [PMID: 33489978 PMCID: PMC7814245 DOI: 10.2147/rru.s290150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Pancreatic tumors account for a small percentage of all malignancies. Most of them are primary and originate from cells of the exocrine pancreas. The remaining primary changes are neuroendocrine tumors. The pancreas may also be a target of metastatic lesions. The most common cancer that metastasizes to the pancreas is renal cell carcinoma. CASE STUDIES The paper presents two cases of rare metastases to organs of the abdominal cavity: the first patient treated surgically due to two metastatic lesions of renal cell carcinoma in the pancreas, diagnosed many years after radical nephrectomy. The second case of high gastrointestinal obstruction in the course of metastasis of renal cell carcinoma to the duodenum. The first patient underwent distal laparotomic resection of the pancreas. The second patient underwent resection of the duodenum and the first jejunal loop with side-to-side duodeno-jejunal anastomosis. Both patients remain under oncological supervision. CONCLUSION Patients after radical nephrectomy due to renal cell carcinoma require long-term systematic monitoring. Due to the anatomical position of the pancreas and duodenum as well as the number, location and size of metastatic lesions, the course of the disease may be initially asymptomatic or oligosymptomatic. Aggressive surgical treatment of pancreatic metastases creates opportunities for long-term survival.
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Affiliation(s)
- Łukasz Piskorz
- Department of General Surgery, Brothers of St John of God Hospital, Lodz, Poland
| | - Kryspin Mitura
- Department of General Surgery, Siedlce Hospital, Siedlce, Poland
- Faculty of Medical and Health Sciences, University of Natural Sciences and Humanities in Siedlce, Siedlce, Poland
| | - Witold Olejniczak
- Department of General Surgery, Brothers of St John of God Hospital, Lodz, Poland
| | - Piotr Misiak
- Clinic of the Chest Surgery, General and Oncological Surgery, Military Medical Academy University Teaching Hospital – Central Veterans’ Hospital, Lodz, Poland
| | - Slawomir Jablonski
- Clinic of the Chest Surgery, General and Oncological Surgery, Military Medical Academy University Teaching Hospital – Central Veterans’ Hospital, Lodz, Poland
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22
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Kouhen F, Chihabeddine M, Squali M, Allaoui M, Bouzidi AA, Errafiy N, Ismaili N. Metastasis to the pancreas: a rare site for secondary malignancy of breast cancer (a case report). Pan Afr Med J 2020; 37:260. [PMID: 33598075 PMCID: PMC7864279 DOI: 10.11604/pamj.2020.37.260.25228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/09/2020] [Indexed: 11/11/2022] Open
Abstract
Breast cancer is the most frequent invasive cancer in women and the second cause of death by cancer in women after lung cancer. It causes metastases especially to bones, liver and lungs. Pancreatic metastases from a primary breast neoplasm are rare and unusual, occurring in less than 3% of the cases. There have been only 28 cases described in the literature. This paper adds one more case to the published literature. We present a case of pancreatic metastasis of the breast in a 64-year-old female and a discussion based on a review of the literature.
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Affiliation(s)
- Fadila Kouhen
- Mohammed VI University of Health Sciences (UM6SS), Department of Radiotherapy, International University Hospital Sheikh Khalifa, Casablanca, Morocco
| | - Meriem Chihabeddine
- Mohammed VI University of Health Sciences (UM6SS), Department of Radiotherapy, International University Hospital Sheikh Khalifa, Casablanca, Morocco
| | - Mohammed Squali
- Mohammed VI University of Health Sciences (UM6SS), Department of Medical Oncology, International University Hospital Sheikh Khalifa, Casablanca, Morocco
| | - Mohammed Allaoui
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.,Department of Pathology, Military Hospital Mohammed V, Rabat, Morocco
| | - Abderrahmane Al Bouzidi
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.,Department of Pathology, Military Hospital Mohammed V, Rabat, Morocco
| | - Nadia Errafiy
- Mohammed VI University of Health Sciences (UM6SS), National Reference Laboratory (LNR), Casablanca, Morocco
| | - Nabil Ismaili
- Mohammed VI University of Health Sciences (UM6SS), Department of Medical Oncology, International University Hospital Sheikh Khalifa, Casablanca, Morocco
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23
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Weng W, Tsai T, Chen W, Cheng J, Sun W. Malignant uveal melanoma with metastatic recurrence to the pancreas: A case report. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wei‐Chun Weng
- Division of Gastroenterology, Department of Internal Medicine Kaohsiung Armed Forces General Hospital Kaohsiung Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Tzung‐Jiun Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Faculty of Medicine, National Yang Ming University Taipei Taiwan
| | - Wen‐Chi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Faculty of Medicine, National Yang Ming University Taipei Taiwan
| | - Jin‐Shiung Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Faculty of Medicine, National Yang Ming University Taipei Taiwan
| | - Wei‐Chih Sun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Kaohsiung Veterans General Hospital Kaohsiung Taiwan
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24
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Sellner F. Isolated Pancreatic Metastases of Renal Cell Carcinoma-A Paradigm of a Seed and Soil Mechanism: A Literature Analysis of 1,034 Observations. Front Oncol 2020; 10:709. [PMID: 32547940 PMCID: PMC7273884 DOI: 10.3389/fonc.2020.00709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 12/15/2022] Open
Abstract
Previously documented arguments, in favor of the suspected impact of a seed and soil mechanism, in the development and progression of isolated pancreatic metastasis of renal cell carcinomas (isPM) are: (1) uniform and independent from the side of the primary tumor distribution of isPM within the pancreas and, (2) the similar survival rates for singular and multiple isPM. In addition, the present study adds new arguments that further confirm the importance of an seed and soil mechanism in isPM: (1) Within the singular isPM, the size of the metastasis does not affect the overall survival; (2) Within the group of multiple isPMs, the overall survival does not depend on the number of metastases; (3) For synchronous and metachronous isPM, survival rates are also not different, and (4) Within the group of metachronous isPM there is also no correlation between the overall survival and interval until metastases occurs. This unusual ineffectiveness of otherwise known risk factors of solid cancers can be explained plausibly by the hypothesis of a very selective seed and soil mechanism in isPM. It only allows embolized renal carcinoma cells in the pancreas to complete all steps required to grow into clinically manifest metastases. In all other organs, on the other hand, the body is able to eliminate the embolized tumor cells or at least put them into a dormant state for many years. This minimizes the risk of occult micrometastases in distant organs, which could later—after isPM treatment—grow into clinically manifest metastases, so that the prognosis of the isPM is only determined by an adequate therapy of the pancreatic foci, and prognostic factors, such as total tumor burden or interval until the occurrence of the isPM remain ineffective.
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Affiliation(s)
- Franz Sellner
- Surgical Department, Kaiser Franz Josef Hospital, Vienna, Austria
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Watanabe A, Harimoto N, Yamanaka T, Ishii N, Tsukagoshi M, Igarashi T, Kubo N, Araki K, Suzuki A, Hara K, Shirabe K. Rare metastatic pancreatic tumors from lung cancer with cystic changes resembling intraductal papillary mucinous neoplasm: a case report. Surg Case Rep 2020; 6:117. [PMID: 32468270 PMCID: PMC7256150 DOI: 10.1186/s40792-020-00870-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastatic pancreatic tumors from lung cancer (MPTLC) constitute 3% of all metastatic pancreatic tumors. We present an extremely rare case of cystic MPTLC that was difficult to distinguish from intraductal papillary mucinous neoplasm (IPMN). CASE PRESENTATION The patient was a 74-year-old woman who underwent lobectomy of lung cancer 2 years before presentation to our hospital. She was referred to our department for resection of cystic pancreatic tumors, which were diagnosed as IPMN with high-risk stigmata. Abdominal computed tomography (CT) showed a 37-mm-wide cystic tumor with a contrasted solid nodule in the pancreatic head and a 17-mm-wide cystic tumor in the pancreatic tail. We performed a total pancreatectomy for these lesions. According to histopathological and immunohistochemical findings, the tumors were diagnosed as metastatic pancreatic tumors from lung cancer. CONCLUSION In this case, the cystic morphology was formed by eosinophilic secretions from tumor cells, and it was difficult to distinguish from IPMN with high-risk stigmata. We consider this case, based on the variable clinical findings, an extremely rare variant of MPTLC.
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Affiliation(s)
- Akira Watanabe
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Norifumi Harimoto
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan. .,Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Gunma, 371-8511, Japan.
| | - Takahiro Yamanaka
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Mariko Tsukagoshi
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan.,Department of Innovative Cancer Immunotherapy, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Takamichi Igarashi
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Norio Kubo
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Aya Suzuki
- Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Hara
- Department of Pathology, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Division of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showamachi, Maebashi, Gunma, 371-8511, Japan
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Jaen-Torrejimeno I, Rojas-Holguín A, López-Guerra D, Ramia JM, Blanco-Fernández G. Pancreatic resection for metastatic renal cell carcinoma. A systematic review. HPB (Oxford) 2020; 22:479-486. [PMID: 31672281 DOI: 10.1016/j.hpb.2019.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Renal cell carcinoma (RCC) can lead to secondary pancreatic tumors even years after nephrectomy was performed. Surgical resection in selected patients shows appropriate survival rates. METHODS A systematic review was performed following PRISMA guidelines. This review finished in May 2019 and included patients with resected pancreatic metastasis(es). The main purpose was to evaluate the results of surgical resection of pancreatic tumors secondary to kidney cancer. RESULTS After the screening process of articles, 21 were selected for the systematic review, which included 354 patients, whose disease-free interval (DFI) was 105.11 (0-361.56) months. Of these patients, 34.6% had additional metastases elsewhere at the time of the surgery, and 48.6% were symptomatic. Postoperative morbidity was 40.2%, The 5-year overall survival (OS) rate was 53.9% (26-75). CONCLUSION Pancreatic surgery for the resection of RCC metastasis(es) is considered safe and shows low morbidity and mortality rates among selected patients in medical institutions where this type of procedure is commonly performed.
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Affiliation(s)
- Isabel Jaen-Torrejimeno
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura, Badajoz, Spain
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura, Badajoz, Spain
| | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura, Badajoz, Spain.
| | - Jose M Ramia
- Department of Surgery, Guadalajara University Hospital, University of Alcala, Guadalajara, Spain
| | - Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, University Complex Hospital Badajoz, University of Extremadura, Badajoz, Spain
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Chikhladze S, Lederer AK, Kühlbrey CM, Hipp J, Sick O, Fichtner-Feigl S, Wittel UA. Curative-intent pancreas resection for pancreatic metastases: surgical and oncological results. Clin Exp Metastasis 2020; 37:313-324. [PMID: 32095913 PMCID: PMC7138763 DOI: 10.1007/s10585-020-10029-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
Background Pancreatic metastasis is a rare cause for pancreas surgery and often a sign of advanced disease no chance of curative-intent treatment. However, surgery for metastasis might be a promising approach to improve patients’ survival. The aim of this study was to analyze the surgical and oncological outcome after pancreatic resection of pancreatic metastasis. Methods This is a retrospective cohort analysis of a prospectively-managed database of patients undergoing pancreatic resection at the University of Freiburg Pancreatic Center from 2005 to 2017. Results In total, 29 of 1297 (2%) patients underwent pancreatic resection due to pancreatic metastasis. 20 (69%) patients showed metastasis of renal cell carcinoma (mRCC), followed by metastasis of melanoma (n = 5, 17%), colon cancer (n = 2, 7%), ovarian cancer (n = 1, 3%) and neuroendocrine tumor of small intestine (n = 1, 3%). Two (7%) patients died perioperatively. Median follow-up was 76.4 (range 21–132) months. 5-year and overall survival rates were 82% (mRCC 89% vs. non-mRCC 67%) and 70% (mRCC 78% vs. non-mRCC 57%), respectively. Patients with mRCC had shorter disease-free survival (14 vs. 22 months) than patients with other primary tumor entities. Conclusion Despite malignant disease, overall survival of patients after metastasectomy for pancreatic metastasis is acceptable. Better survival appears to be associated with the primary tumor entity. Further research should focus on molecular markers to elucidate the mechanisms of pancreatic metastasis to choose the suitable therapeutic approach for the individual patient.
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Affiliation(s)
- Sophia Chikhladze
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany.
| | - Ann-Kathrin Lederer
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany.,Center for Complementary Medicine, Department of Environmental Health Sciences and Hospital Infection Control, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 115b, 79106, Freiburg im Breisgau, Germany
| | - Christian M Kühlbrey
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany
| | - Julian Hipp
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany
| | - Olivia Sick
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany
| | - Uwe A Wittel
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg im Breisgau, Germany
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Koizumi W, Kitago M, Shinoda M, Yagi H, Abe Y, Oshima G, Hori S, Inomata K, Kawakubo H, Kawaida M, Kitagawa Y. Successful resection of pancreatic metastasis from oesophageal squamous cell carcinoma: a case report and review of the literature. BMC Cancer 2019; 19:320. [PMID: 30953505 PMCID: PMC6451211 DOI: 10.1186/s12885-019-5549-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/28/2019] [Indexed: 12/29/2022] Open
Abstract
Background Oesophageal cancer has a high metastatic potential and poor prognosis, with a significant risk of recurrence after radical resection. However, resected pancreatic metastasis from oesophageal cancer is rare. Case presentation Eleven years prior, a seventy-year-old woman had been treated with transthoracic radical oesophagectomy for oesophageal squamous cell carcinoma. Four years prior, she had undergone chemotherapy for lymph node recurrence at the splenic hilum and achieved a partial response. She had also received chemoradiotherapy for lymph node recurrence at the splenic hilum 3 years prior; a complete response was achieved. However, routine follow-up with abdominal computed tomography recently revealed a tumour at the pancreatic tail and swollen lymph nodes. The patient underwent distal pancreatectomy on the basis of a pre-operative diagnosis of primary pancreatic cancer, although a histological examination of the surgical specimen revealed metastatic squamous cell carcinoma that was compatible with metachronous pancreatic metastasis from oesophageal squamous cell carcinoma. The patient has been undergoing clinical follow-up without adjuvant therapy and has been disease-free for 24 months after resection of the pancreatic metastasis. Conclusions Resection of pancreatic metastasis may improve prognosis and should be considered when treating patients with solitary metastasis from oesophageal squamous cell carcinoma.
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Affiliation(s)
- Wataru Koizumi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Go Oshima
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenta Inomata
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Miho Kawaida
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Huang Q, Zhou H, Liu C, Jin K, Fan K, Cheng H, Fan Z, Yang C, Liu L, Long J, Xu J, Ni Q, Hu Z, Yu X. Surgical Resection for Metastatic Tumors in the Pancreas: A Single-Center Experience and Systematic Review. Ann Surg Oncol 2019; 26:1649-1656. [PMID: 30924017 DOI: 10.1245/s10434-019-07258-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metastatic lesion to the pancreas accounts for approximately 2% of pancreatic neoplasms. There is no prospective, randomized or case-controlled study evaluating the role of pancreatic metastasectomy. METHODS The PubMed, EMBASE, and Cochrane Library electronic databases were searched for studies published between January 1, 2001 and December 31, 2017. Studies with five or more patients who received pancreatic metastasectomy and data from our institution (29 patients) were included. The Kaplan-Meier method was used for survival analysis. RESULTS A total of 414 patients from 20 institutions who underwent pancreatic resections were included. Of the reported 31 kinds of primary neoplasms, renal-cell carcinoma (RCC) comprised the most (54.3%). At the time of diagnosis, although 40.3% patients were asymptomatic, abdominal pain (34.8%) and jaundice (20.6%) were relatively common. As for surgical type, pancreatoduodenectomy, total pancreatectomy, distal pancreatectomy, and enucleation took up 37.9%, 11.4%, 43.5%, and 7.2% respectively. The mortality and morbidity rates were 1.4% and 48.3% respectively. Patients with symptoms at the time of diagnosis had significantly shorter survival compared with asymptomatic patients (p = 0.017). Those with RCC as primary tumor had significantly longer survival compared with non-RCC patients (p < 0.001). Positive margin also predicts worse prognosis (p = 0.035). CONCLUSIONS Pancreatic metastasectomy is safe and associated with acceptable short- and intermediate-term results. In the conditions of RCC as the primary tumor, being asymptomatic, or negative resection margin, a better prognosis after resection can be achieved.
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Affiliation(s)
- Qiuyi Huang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Haiyang Zhou
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Chen Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Kaizhou Jin
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Kun Fan
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - He Cheng
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Zhiyao Fan
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Chao Yang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Liang Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Jiang Long
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Jin Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Quanxing Ni
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China.,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China
| | - Zhiqian Hu
- Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China. .,Department of Oncology, Fudan University Shanghai Medical College, Shanghai, People's Republic of China. .,Shanghai Pancreatic Cancer Institute, Shanghai, People's Republic of China.
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Differentiation of pancreatic neuroendocrine tumors from pancreas renal cell carcinoma metastases on CT using qualitative and quantitative features. Abdom Radiol (NY) 2019; 44:992-999. [PMID: 30603880 DOI: 10.1007/s00261-018-01889-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess qualitative and quantitative imaging features on enhanced CT that may differentiate pancreatic neuroendocrine tumors (PNETs) from pancreatic renal cell carcinoma (RCC) metastases. METHODS This IRB-approved multi-center retrospective case-control study compared 43 resected PNETs and 28 resected RCC metastases with pre-operative enhanced CT identified consecutively between 2003 and 2017. Two blinded radiologists (R1/R2) independently assessed tumor location, attenuation (relative to pancreas), composition (solid/cystic/mixed), homogeneity (homogeneous/heterogeneous), calcification, multiplicity, and for main pancreatic duct (MPD) dilation. Tumors were segmented for quantitative texture analysis. Data were analyzed with Chi square, logistic regression, and receiver operating characteristic (ROC). Inter-observer agreement was assessed (Cohen's kappa). RESULTS There was no difference in age, gender, location, attenuation, or composition (P > 0.05) between groups. PNETs were larger than RCC metastases (37 ± 23 mm vs. 26 ± 21 mm, P = 0.038), more frequently solitary (P < 0.001), subjectively more heterogeneous (P = 0.033/0.144, R1/R2), and associated with calcification (P = 0.002/0.004) and MPD dilation (P = 0.025/0.006). Agreement for subjective features was moderate-to-almost perfect (K = 0.4879-0.9481). Quantitative texture analysis showed higher entropy in PNETs (6.32 ± 0.49 versus 5.96 ± 0.53; P = 0.004) with no difference in other features studied (P > 0.05). Entropy had ROC area under the curve for diagnosis of PNET of 0.77 ± 0.06, with optimal sensitivity/specificity of 71.4/79.1%. CONCLUSIONS Compared to pancreatic RCC metastases, PNETs are larger, more frequently solitary, contain calcification, show MPD dilation, and are subjectively and quantitatively more heterogeneous tumors.
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Apodaca-Rueda M, Chaim FHM, Garcia MDS, de Saito HPDA, Gestic MA, Utrini MP, Callejas-Neto F, Chaim EA, Cazzo E. Solitary pancreatic metastasis from breast cancer: case report and review of literature. SAO PAULO MED J 2019; 137:201-205. [PMID: 29116313 PMCID: PMC9721236 DOI: 10.1590/1516-3180.2017.0144260617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Pancreatic metastases from primary malignant tumors at other sites are rare, constituting about 2% of the neoplasms that affect the pancreas. Pancreatic metastasis from breast cancer is extremely rare and difficult to diagnose, because its clinical and radiological presentation is similar to that of a primary pancreatic tumor. CASE REPORT A 64-year-old female developed a lesion in the pancreatic tail 24 months after neoadjuvant therapy, surgery and adjuvant radiation therapy for right-side breast cancer (ductal carcinoma). She underwent distal pancreatectomy with splenectomy and left adrenalectomy, and presented an uneventful outcome. The immunohistochemical analysis on the surgical specimen suggested that the lesion originated from the breast. CONCLUSION In cases of pancreatic lesions detected in patients with a previous history of breast neoplasm, the possibility of pancreatic metastasis should be carefully considered.
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Affiliation(s)
- Márcio Apodaca-Rueda
- Medical Student, Faculdade de Medicina da Pontificia Universidade Católica de Campinas (PUC-Campinas), Campinas (SP), Brazil
| | - Fábio Henrique Mendonça Chaim
- MD. Resident Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Milena da Silva Garcia
- MD. Resident Physician, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Helena Paes de Almeida de Saito
- MD. Assistant Lecturer, Oncology Unit - Department of Internal Medicine, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Martinho Antonio Gestic
- MD, MSc. Assistant Lecturer, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Murillo Pimentel Utrini
- MD, MSc. Assistant Lecturer, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Francisco Callejas-Neto
- MD, MSc. Assistant Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Elinton Adami Chaim
- MD, MSc, PhD. Full Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
| | - Everton Cazzo
- MD, PhD. Adjunct Professor, Department of Surgery, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (FCM-UNICAMP), Campinas (SP), Brazil
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Liu X, Feng F, Wang T, Qin J, Yin X, Meng G, Yan C, Xing Z, Duan J, Liu C, Liu J. Laparoscopic pancreaticoduodenectomy for metastatic pancreatic melanoma: A case report. Medicine (Baltimore) 2018; 97:e12940. [PMID: 30383642 PMCID: PMC6221747 DOI: 10.1097/md.0000000000012940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/25/2018] [Indexed: 02/03/2023] Open
Abstract
RATIONALE Pancreatic metastases from other malignant tumors are an uncommon clinical condition and account for approximately 2% of all pancreatic malignancies. The most common primary malignancy that metastasizes to pancreas is renal cell cancer. We reported a rare clinical case of metastatic melanoma to pancreas who underwent a successful laparoscopic pancreaticoduodenectomy (LPD) at our department. PATIENT CONCERNS A 54-year-old Chinese man complaining an unexplained jaundice was found to have a pancreatic mass and he was diagnosed with cutaneous melanoma (CM) 6 years ago. DIAGNOSES Contrast-enhanced computed tomography (CECT) revealed a solid hypovascular mass measuring about 3.1 × 2.4 cm localized at the junction of pancreatic head and uncinate process, which compressed the lower common bile duct resulting in expansion of the upstream bile ducts. INTERVENTIONS We performed an LPD and regional lymphadenectomy on this patient. OUTCOMES This patient was discharged home on postoperative day 19. Postoperative pathological results revealed a malignant melanoma with negative margins. Immunohistochemical (IHC) findings also suggested a malignant pancreatic tumor accompanied by necrosis and pigmentation, which confirmed the pathological diagnosis. Immunoreactivity was strongly positive for anti-S-100 protein (+++) and positive for anti-Vimentin (+). The cancer cells were negative for CEA, CK8/18, P53, Violin, CK19, SMA with Ki-67 over 40%. So this pancreatic mass was proved to be a metastatic pancreatic melanoma from the primary cutaneous lesion. After LPD, this patient was followed up by readmission to hospital every 2 month in the first half year. The serum bilirubin and tumor markers such as CA199 were normal. CECT and did not find any newly developed neoplasm at the pancreas or metastasis at other organs. At the last follow-up at 6 months after LPD, the patient's general condition was acceptable and the physical examination and imaging studies revealed no significant findings of melanoma. LESSONS Metastatic pancreatic tumors are often associated with well-defined margins, tumor necrosis, enhancement, and distant metastases without pancreatic duct dilatation and parenchymal atrophy. As the most common type of metastatic pancreatic tumor, renal cell cancers tend to have higher attenuation values than that of primary pancreatic cancer, while they had similar attenuation values on the portal phase. Primary pancreatic cancer was always associated with an elevated CA199, total bilirubin, and fasting plasma glucose levels. Surgical resection for metastases to pancreas should be aggressively considered in selected patients due to its unique value of providing palliation and a chance to cure. For patients with unresectable lesions, new therapeutic protocols should be recommended such as the combination of BRAF with MEK inhibitor and PD-1 blocker with or without ipilimumab.
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Affiliation(s)
- Xueqing Liu
- Second Hospital of Hebei Medical University, Shijiazhuang
| | - Feng Feng
- Second Hospital of Hebei Medical University, Shijiazhuang
| | - Tianyang Wang
- Second Hospital of Hebei Medical University, Shijiazhuang
| | - Jianzhang Qin
- Second Hospital of Hebei Medical University, Shijiazhuang
| | | | | | - Changqing Yan
- Second Hospital of Hebei Medical University, Shijiazhuang
| | | | - Jiayue Duan
- Second Hospital of Hebei Medical University, Shijiazhuang
| | - Chen Liu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jianhua Liu
- Second Hospital of Hebei Medical University, Shijiazhuang
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Madkhali AA, Shin SH, Song KB, Lee JH, Hwang DW, Park KM, Lee YJ, Kim SC. Pancreatectomy for a secondary metastasis to the pancreas: A single-institution experience. Medicine (Baltimore) 2018; 97:e12653. [PMID: 30334949 PMCID: PMC6211914 DOI: 10.1097/md.0000000000012653] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The aim of the present study was to evaluate the short- and long-term outcomes of secondary metastasis to the pancreas in terms of overall survival (OS) and disease-free survival (DFS) after pancreatectomy.This retrospective study included 29 patients who underwent pancreatectomy for secondary metastasis to the pancreas between December 1995 and August 2016.The study group was divided into renal cell carcinoma (RCC) (17 patients) and non-RCC (12 patients). The non-RCC group had 5 cases of colorectal cancer and 7 of another primary origin. The OS for the whole cohort was 86.2% at 1 year, 63.2% at 3 years, and 46.7% at 5 years. There was no significant difference between the 2 groups at 1, 3, and 5 years survival and OS. In subgroup analysis of patients who underwent curative resection, there was no significant difference in OS between the 2 groups at 1, 3, and 5 years. However, there was a significant difference in recurrence rate at 3 years (P = .035). Pathologic analysis showed that the non-RCC group had significantly more positive lymph node metastasis than the RCC group (P = .002).Pancreatectomy for secondary metastasis has promising short- and long-term outcomes in terms of OS and DFS.
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Affiliation(s)
- Ahmad Abdullah Madkhali
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Hepato-Biliary and Pancreatic Surgery unit, Department of Surgery, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Sang-hyun Shin
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Byung Song
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang Min Park
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Joo Lee
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ito T, Takada R, Omoto S, Tsuda M, Masuda D, Kato H, Matsumoto T, Moriyama I, Okabe Y, Shiomi H, Ishida E, Hatamaru K, Hashimoto S, Tanaka K, Kawamoto H, Yanagisawa A, Katayama T, Yazumi S. Analysis of Prognostic Factors in Pancreatic Metastases: A Multicenter Retrospective Analysis. Pancreas 2018; 47:1033-1039. [PMID: 30048381 DOI: 10.1097/mpa.0000000000001132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Pancreatic metastases (PMs) account for 1% to 2% of pancreatic tumors, and their prognostic significance is poorly defined. We evaluated the incidence and clinical characteristics of primary tumors and defined prognostic factors. METHODS This retrospective study of 39 Japanese tertiary referral hospitals (January 2005 to August 2015) analyzed patient and tumor characteristics and survival time. Kaplan-Meier analysis and Cox proportional hazards models were applied to evaluate overall survival and prognostic factors, respectively. RESULTS We enrolled 159 patients with a pathologic diagnosis of PM. The most common primary tumor was renal cell carcinoma (38.4%), followed by lung cancer (24.5%), colorectal cancer (11.3%), and sarcoma (6.3%). Eight patients were lost during follow-up, and 151 patients were included for statistical analysis. Median overall survival was 43.0 months, and the 5-year survival rate was 42.6%. Multivariate analysis identified 3 independent prognostic factors: extrapancreatic metastasis (hazard ratio, 2.13; 95% confidence interval, 1.11-4.07; P = 0.02), tumor-related symptoms at diagnosis (hazard ratio, 5.39; 95% confidence interval, 2.92-9.91; P < 0.001), and pathologic diagnosis of primary tumors (P < 0.001). CONCLUSIONS Treatment strategies and prognoses for PMs completely differ according to the primary tumor type. A definitive pathologic diagnosis of PMs is essential for selecting the appropriate treatment.
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Affiliation(s)
| | - Ryoji Takada
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty Medicine, Osaka-Sayama, Japan
| | - Motoyuki Tsuda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine Kyoto University, Kyoto, Japan
| | - Daisuke Masuda
- 2nd Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshihiko Matsumoto
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Ichiro Moriyama
- Department of Hematology/Oncology, Shimane University Hospital, Shimane, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hideyuki Shiomi
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Etsuji Ishida
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
| | - Keiichi Hatamaru
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan
| | - Shinichi Hashimoto
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kiyohito Tanaka
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Hirofumi Kawamoto
- Department of Internal Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Akio Yanagisawa
- Department of Surgical Pathology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Toshiro Katayama
- Faculty of Medical Engineering, Himeji Dokkyo University School of Health Care Sciences, Himeji, Japan
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Shatveryan GA, Chardarov NK, Bagmet NN, Ratnikova NP, Bedzhanyan AL, Petrenko KN, Polishchuk LO, Karagyozyan GA. [Isolated pancreatic metastases of renal cell carcinoma]. Khirurgiia (Mosk) 2018:36-40. [PMID: 29286028 DOI: 10.17116/hirurgia20171236-40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To present own experience of surgical treatment of isolated pancreatic metastases of renal cell carcinoma. MATERIAL AND METHODS There are 3 cases of pancreatic metastases of renal cell carcinoma. They were diagnosed in women aged 55, 66 and 67 years in 9, 11 and 23 years after nephrectomy respectively. RESULTS The tumors were placed in head (60 mm), body (10 and 5 mm) and tail (30 mm) of the pancreas. There were 2 distal pancreatectomy with splenectomy and 1 pancreatoduodenectomy. All patients are alive within 39, 49 and 8 months after surgery respectively. One woman has been diagnosed pulmonary metastases after 19 months. 20-month sunitinib administration contributes to regression of the disease. There was no recurrent disease in other two patients. CONCLUSION Isolated pancreatic metastases of renal cell carcinoma can occur in decades after nephrectomy. Therefore, lifelong follow-up is necessary. Pancreatectomy for focal lesion is associated with good long-term outcome.
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Affiliation(s)
- G A Shatveryan
- Department of liver, biliary and pancreatic surgery, Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - N K Chardarov
- Department of liver, biliary and pancreatic surgery, Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - N N Bagmet
- Department of liver, biliary and pancreatic surgery, Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - N P Ratnikova
- Department of liver, biliary and pancreatic surgery, Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - A L Bedzhanyan
- department of coloproctology, Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - K N Petrenko
- department of coloproctology, Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - L O Polishchuk
- department of coloproctology, Petrovsky Russian Research Center for Surgery, Moscow, Russia
| | - G A Karagyozyan
- Department of liver, biliary and pancreatic surgery, Petrovsky Russian Research Center for Surgery, Moscow, Russia
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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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Zheng J, Zhou J, Zhu Y, Shen Q, Zhou J. Significant Radiologic Response of Pancreatic Metastasis After Targeted Therapy of Ceritinib (LDK378) for ALK-Rearranged Lung Adenocarcinoma Presenting With Hyperglycemia. Oncol Res 2017; 25:545-550. [PMID: 28438234 PMCID: PMC7841023 DOI: 10.3727/096504016x14801968368898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pancreatic metastasis from non-small cell lung cancer (NSCLC) is usually asymptomatic or presents with abdominal pain, acute pancreatitis, or jaundice. A lung primary is associated with worse survival compared to pancreatic metastases from other organs. Surgical treatment of solitary metastasis to the pancreas from NSCLC has been reviewed in several studies, one of which had a notable disease-free interval. To our knowledge, there are no prior reports of targeted therapy of pancreatic metastasis of NSCLC followed by a significant response. Herein we report the case of a 31-year-old female with a solitary pancreatic metastasis from ALK-rearranged lung adenocarcinoma despite treatment with chemotherapy and crizotinib; she presented with symptoms of hyperglycemia. Targeted therapy with ceritinib (LDK378) led to symptomatic improvement and a significant radiologic response in the lung and pancreas, but not in the brain.
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Affiliation(s)
- Jing Zheng
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Jianya Zhou
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Yanping Zhu
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Qian Shen
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Jianying Zhou
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P.R. China
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Boussios S, Zerdes I, Batsi O, Papakostas VP, Seraj E, Pentheroudakis G, Glantzounis GK. Pancreatic resection for renal cell carcinoma metastasis: An exceptionally rare coexistence. Int J Surg Case Rep 2016; 27:198-201. [PMID: 27661665 PMCID: PMC5035354 DOI: 10.1016/j.ijscr.2016.08.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/28/2022] Open
Abstract
RCC is the predominant primary tumor for isolated pancreatic metastases. Pancreatic metastases from RCC generally tends to slow growth and indolent behavior. Surgical resection may be curative and should be considered in selected patients. It is still controversial whether to perform typical or atypical surgical procedures. Pancreatic metastasis after a prolonged period may imply change in tumor biology.
Introduction Pancreatic metastases are uncommon and only found in a minority of patients with widespread metastatic disease at autopsy. The most common primary cancer site resulting in pancreatic metastases is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma. Presentation of case Herein, we report a 63-year-old male patient who presented −3.5 years after radical nephrectomy performed for renal cell carcinoma (RCC)-with a well-defined lobular, round mass at the body of the pancreas demonstrated by abdominal Magnetic Resonance Imaging (MRI). The patient underwent distal pancreatectomy combined with splenectomy and cholecystectomy. Histopathological examination revealed clusters of epithelial clear cells, immunohistochemically positive for RCC marker, and negative for CD10 and CA19-9. A final diagnosis of clear RCC metastasizing to pancreas was obtained in view of the past history of RCC, microscopy and the immunoprofile. This was the second metachronous disease recurrence after a previous metastatic involvement of the liver, developed 19 months from the initial diagnosis. The patient has remained well at a 6 month follow up post-resection. Discussion Solitary pancreatic metastases may be misdiagnosed as primary pancreatic cancer. However, imaging including computed tomography (CT) and MRI, may discriminate between them. Surgical procedures could differentiate solitary metastasis from neuroendocrine neoplasms. The optimal resection strategy involves adequate resection margins and maximal tissue preservation of the pancreas. Conclusion Recently, an increasing number of surgical resections have been performed in selected patients with limited metastatic disease to the pancreas. In addition, a rigid follow-up scheme, including endoscopic ultrasound (EUS) and CT is essential give patients a chance for a prolonged life.
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Affiliation(s)
- Stergios Boussios
- Department of Medical Oncology, Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Greece.
| | - Ioannis Zerdes
- Department of Medical Oncology, Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Greece
| | - Ourania Batsi
- Department of Pathology, Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Greece
| | | | - Esmeralda Seraj
- Department of Medical Oncology, Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Greece
| | - George Pentheroudakis
- Department of Medical Oncology, Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Greece
| | - George K Glantzounis
- HPB Unit, Department of Surgery, University Hospital of Ioannina and Medical School, University of Ioannina, Stavros Niarchou Avenue, 45110 Greece
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Sbitti Y, Seddik H, Debbagh A, Benani F, Slimani K, Mahi M, Tarchouli M, Aitali A, Albouzidi A, Errihani H, Ichou M. Metachronous pancreatic metastases from renal cell carcinoma: is there a place of Active-Surveillance before deferred deliberately Molecular Target Agent? World J Surg Oncol 2016; 14:222. [PMID: 27553296 PMCID: PMC4995784 DOI: 10.1186/s12957-016-0939-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/08/2016] [Indexed: 12/15/2022] Open
Abstract
Background Metastatic renal cell cancer is a heterogeneous disease due to its diverse morphological features, the prognostic categories based on clinical criteria. Sometimes indolent course without any significant symptoms can be differentiated before the introduction of novel targeted agents. This observation led to interest in a strategy of deferring systemic therapy in the era of effective systemic therapies. Case presentation We report of a 78-year-old Moroccan man with pancreatic metastasis from renal cell carcinoma which occurred 14 years from right nephrectomy. Indolent disease based on body computed tomography imaging with 4 years follow-up was recognized. Active surveillance with deferred antiangiogenic multikinase inhibitor at disease progression was proposed. Nowadays, the patient is under oncological follow-up, he is in a good state of health, and he is disease-free for 48 months from the diagnosis of the tumor and for 20 months from the start of the treatment with Sunitinib Conclusions Active surveillance before target therapy may be a suitable approach to ensure long progression-free survival with minimal side-effects and better quality of life in asymptomatic, low-volume, metastatic disease. Further prospective studies with biomarker validation are required to define the patients most likely to benefit from this approach.
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Affiliation(s)
- Yassir Sbitti
- Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco. .,Department Medical Oncology, Teaching University Military Hospital and Faculty of Medicine and Pharmacy of Fes, Hay Ryad, Rabat, 10000, Morocco.
| | - Hassan Seddik
- Department of Gastroenterology, University Military Hospital, Rabat, 10000, Morocco
| | - Adil Debbagh
- Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco
| | - Fahd Benani
- Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco
| | - Khaoula Slimani
- Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco
| | - Mohamed Mahi
- Department of Pathology, University Military Hospital of Instruction, Rabat, 10000, Morocco
| | - Mohamed Tarchouli
- Department of Surgery, University Military Hospital of Instruction, Rabat, 10000, Morocco
| | - Abdelmounaim Aitali
- Department of Pathology, University Military Hospital of Instruction, Rabat, 10000, Morocco
| | - Abderrahmane Albouzidi
- Department of Radiology, University Military Hospital of Instruction, Rabat, 10000, Morocco
| | - Hassan Errihani
- Department of Medical Oncology, National Institute of Oncology, Rabat, 10000, Morocco
| | - Mohamed Ichou
- Department of Medical Oncology, University Military Hospital, Rabat, 10000, Morocco
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Abstract
BACKGROUND Renal cell carcinoma (RCC) is a common cancer, but pancreatic metastasis of RCC is unusual. Because of the rarity and peculiarity, pancreatic lesions from RCC metastasis were described mostly in case reports which highlight the importance of a systematic analysis of this clinical condition. DATA SOURCES Data of 7 patients with pancreatic metastasis of RCC treated in the Peking Union Medical College Hospital were extracted and 193 similar patients reported in the past 10 years from the literature were analyzed. Epidemiological, pathological and follow-up information were investigated. Potential prognostic factors were compared with corresponding data reported 10 years ago. RESULTS Multivariate Cox regression showed that asymptomatic metastasis and surgical procedure were independent factors associated with better survival. Compared with the data reported 10 years ago, follow-up of RCC patients has been emphasized in recent years, and atypical surgery is frequently used since it has similar effect as typical surgery on tumor resection while it is able to preserve more pancreatic function. CONCLUSION Surgical treatment should be an option as long as the pancreatic metastasis of RCC is resectable.
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Affiliation(s)
- Jie Dong
- Department of General Surgery, and National Laboratory of Medical Molecular Biology, Chinese Academy of Medical Sciences, Medical College Hospital, Peking Union Medical College, Beijing 100730, China.
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Krishna SG, Bhattacharya A, Ross WA, Ladha H, Porter K, Bhutani MS, Lee JH. Pretest prediction and diagnosis of metastatic lesions to the pancreas by endoscopic ultrasound-guided fine needle aspiration. J Gastroenterol Hepatol 2015; 30:1552-60. [PMID: 25867963 DOI: 10.1111/jgh.12973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Early diagnosis of solid pancreatic lesions (SPLs) enables prompt treatment. The study aims to identify factors differentiating metastatic lesion to the pancreas (PMET) from pancreatic ductal adenocarcinoma (PDAC) and pancreatic neuroendocrine tumors (PNETs). METHODS This is a retrospective study at a tertiary cancer center. Consecutive patients referred for endoscopic ultrasound (EUS) of SPLs from 2004 to 2011 were reviewed. The main outcomes were pre-EUS-FNA (endoscopic ultrasound-guided fine needle aspiration) predictors and diagnostic accuracy of EUS-FNA for PMETs. RESULTS Among a total of 1108 EUS-FNAs for pancreatic lesions, 672 patients had neoplastic SPLs (PMETs = 53; PDACs = 528, PNETs = 91). The sensitivity, specificity, positive predictive value, and accuracy of EUS-FNA for diagnosis of PMETs were 84.9%, 100%, 100%, and 98.8%, respectively. The mean number of EUS-FNA passes for diagnosis of PMET was 3.1 per patient. For each endosonographer, preceding 3-year EUS volume (mean/year) significantly correlated with fewer needle passes (rs [-0.30], P = 0.03). The most common PMET was renal cell carcinoma. Stratified multivariate analyses were performed. Compared with patients with PDACs, PMETs were more common in men (odds ratio [OR] = 2.0; 95% confidence interval [CI] = 1.0-4.0); located in the pancreatic tail (OR = 2.4; 95%CI = 1.1-5.2); and were less likely with increasing age (OR = 0.95; 95%CI = 0.92-0.99), presence of major symptoms (abdomen pain/diarrhea/weight loss; OR = 0.2; 95%CI = 0.1-0.4), elevated bilirubin (OR = 0.3; 95%CI = 0.13-0.69), and imaging evidence of arterial invasion (OR = 0.15; 95%CI = 0.03-0.67). Compared with PNETs, PMETs were more common with increase age (OR = 1.05; 95%CI = 1.02-1.08) and increasing lesion size (OR = 1.03; 95%CI = 1.0-1.1), and were less likely in patients with diabetes (OR = 0.34; 95%CI = 0.11-0.99). CONCLUSION Among the largest numbers of neoplastic SPLs evaluated at a single center, pre-test features reliably characterize, and EUS-FNA provides a highly specific diagnosis of PMETs.
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Affiliation(s)
- Somashekar G Krishna
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Abhik Bhattacharya
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - William A Ross
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harshad Ladha
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kyle Porter
- Department of Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Yuasa T, Inoshita N, Saiura A, Yamamoto S, Urakami S, Masuda H, Fujii Y, Fukui I, Ishikawa Y, Yonese J. Clinical outcome of patients with pancreatic metastases from renal cell cancer. BMC Cancer 2015; 15:46. [PMID: 25872621 PMCID: PMC4332740 DOI: 10.1186/s12885-015-1050-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/28/2015] [Indexed: 02/06/2023] Open
Abstract
Background Renal cell cancer (RCC) is one of the most frequent primary sites for metastatic pancreatic tumors although metastatic tumors are rare among pancreatic malignant tumors. The purpose of this study is to disclose the characterization and treatment outcomes of pancreatic metastases from RCC. Methods Of 262 patients with metastatic RCC treated at our hospital between 1999 and 2013, the data of 20 (7.6%) who simultaneously developed or subsequently acquired pancreatic metastases were retrospectively reviewed and statistically analyzed. Results The median follow-up period from RCC diagnosis and pancreatic metastases was 13.4 years (inter-quartile range: IQR, 7.8–15.5 years) and 3.8 years (IQR, 2.1–5.5 years), respectively. Median duration from diagnosis of RCC to pancreatic metastasis was 7.8 years (IQR, 4.2–12.7 years). During this observation period, the estimated median overall survival (OS) time from the diagnosis of RCC to death or from pancreatic metastasis to death was not reached. The probability of patients surviving after pancreatic metastasis at 1, 3, and 5 years was 100, 87.7, and 78.9%, respectively. The estimated OS period from the diagnosis of metastases to death of the patients with pancreatic metastasis was significantly longer than that of the patients with non-pancreatic metastasis (median OS 2.7 years) (P < 0.0001). Surgical management for pancreatic metastasis was performed in 15 patients (75%). When the median follow-up period for these surgeries was 3.5 years (IQR, 1.9–5.2 years), the estimated median recurrence-free survival was 1.8 years. For the patients with multiple metastatic sites, molecularly targeted therapies were given to six (30%) patients. When the median follow-up period was 4.1 years (IQR, 3.0–4.4 years), no disease progression was observed. Conclusions The pancreas is frequently the only metastatic site and metastasis typically occurs a long time after nephrectomy. The OS period of these patients is long and both surgical and medical treatment resulted in good outcomes.
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Sperti C, Moletta L, Patanè G. Metastatic tumors to the pancreas: The role of surgery. World J Gastrointest Oncol 2014; 6:381-392. [PMID: 25320654 PMCID: PMC4197429 DOI: 10.4251/wjgo.v6.i10.381] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/06/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
Pancreatic metastases from other primary malignancies are a rare entity. By far, the most common primary cancer site resulting in an isolated pancreatic metastasis is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma. Only few data on the surgical outcome of pancreatic resections performed for metastases from other primary tumor have been published, and there are no guidelines to address the surgical treatment for these patients. In this study, we performed a review of the published literature, focusing on the early and long-term results of surgery for the most frequent primary tumors metastasizing to the pancreas. Results for the Literature’s analysis show that in last years an increasing number of surgical resections have been performed in selected patients with limited pancreatic disease. Pancreatic resection for metastatic disease can be performed with acceptable mortality and morbidity rates. The usefulness of pancreatic resection is mainly linked to the biology of the primary tumor metastasizing to the pancreas. The benefit of metastasectomy in terms of patient survival has been observed for metastases from renal cell cancer, while for other primary tumors, such as lung and breast cancers, the role of surgery is mainly palliative.
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Schwarz L, Sauvanet A, Regenet N, Mabrut JY, Gigot JF, Housseau E, Millat B, Ouaissi M, Gayet B, Fuks D, Tuech JJ. Long-term survival after pancreatic resection for renal cell carcinoma metastasis. Ann Surg Oncol 2014; 21:4007-13. [PMID: 24879589 DOI: 10.1245/s10434-014-3821-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical resection of pancreatic metastasis (PM) is the only reported curative treatment for renal cell carcinoma. However, there is currently little information regarding very long-term survival. The primary objective of this study was to determine the 10-year survival of this condition using the largest surgical series reported to date. METHODS Between May 1987 and June 2003, we conducted a retrospective study of 62 patients surgically treated for PM from renal cell carcinoma at 12 Franco-Belgian surgical centers. Follow-up ended on May 31, 2012. RESULTS There were 27 male (44 %) and 35 female (56 %) patients with a median age of 54 years [31-75]. Mean disease-free interval from resection of primary tumor to reoperation for pancreatic recurrence was 9.8 years (median 10 years [0-25]). During a median follow-up of 91 months [12-250], 37 recurrences (60 %) were observed. After surgical resection of repeated recurrences, overall median survival time was 52.6 months versus 11.2 months after nonoperative management (p = 0.019). Cumulative 3-, 5-, and 10-year overall survival (OS) rates were 72, 63, and 32 %, respectively. The corresponding disease-free survival rates were 54, 35, and 27 %, respectively. Lymph node involvement and existence of extrapancreatic metastases before PM were associated with poor overall survival. CONCLUSIONS Aggressive surgical management of single or multiple PM, even in cases of extrapancreatic disease, should be considered in selected patients to allow a chance of long-term survival.
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Affiliation(s)
- L Schwarz
- Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen, France
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Vincenzi M, Pasquotti G, Polverosi R, Pasquali C, Pomerri F. Imaging of pancreatic metastases from renal cell carcinoma. Cancer Imaging 2014; 14:5. [PMID: 25609358 PMCID: PMC4212532 DOI: 10.1186/1470-7330-14-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/28/2014] [Indexed: 11/13/2022] Open
Abstract
Background To describe the main imaging characteristics of pancreatic metastases from renal cell carcinoma (RCC) with particular attention to CT features, underlining possible criteria for a differential diagnosis. Methods 15 patients have been included in this study. 14 patients underwent multislice CT with triphasic acquisition (unenhanced, pancreatic parenchymal and portal venous phases). In 9 cases a delayed phase (120 sec) was also acquired. 5 patients underwent MRI, before and after administration of gadolinium. Results The mean time interval between nephrectomy and recurrence was 7.5 years (range 1-17 years). On CT metastases avidly enhanced in the parenchymal phase and then demonstrated a significant wash-out, approaching isodensity to the normal pancreatic parenchyma in the portal phase. In the portal phase 20 of the 25 lesions found in the arterial phase were recognizable. On non-enhanced scans, only 13 of the 25 lesions were detected. On MRI, with the limitations due to the paucity of cases, the metastatic foci appeared hypointense to normal pancreatic tissue on T1-weighted images, and hyperintense on T2- and diffusion-weighted images. After gadolinium, the behaviour was similar to that reported for CT, except for one patient in whom two metastatic foci presented a signal intensity almost isointense to the surrounding parenchyma, accompanied also by an unusual lowering of the signal on DWI (diffusion-weighted imaging) with high b-values. Compared to CT, with MRI the lesions appeared all detectable even on non-enhanced acquisitions. Conclusion Renal Cell Carcinomas require a prolonged CT or MRI follow-up. In patients with RCC history, an early arterial or a pancreatic parenchymal phase is always mandatory, as pancreatic metastases typically present themselves as hypervascular lesions. This behavior is similar to that of neuroendocrine tumors, while the other primary pancreatic tumors tend to be hypovascular.
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Waters L, Si Q, Caraway N, Mody D, Staerkel G, Sneige N. Secondary tumors of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a 10-year experience. Diagn Cytopathol 2014; 42:738-43. [PMID: 24554612 DOI: 10.1002/dc.23114] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/05/2013] [Accepted: 01/09/2014] [Indexed: 01/11/2023]
Abstract
Determining whether a pancreatic mass is a primary or secondary neoplasm is necessary for appropriate treatment. We reviewed our experience using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of pancreatic tumors to identify clinical and cytopathologic characteristics of metastatic disease. We reviewed all cases of tumors metastatic to the pancreas evaluated at The University of Texas MD Anderson Cancer Center and The Methodist Hospital in Houston, Texas during the period from 2002 to 2012. The review included cytologic specimens, clinical history, radiologic findings, primary tumor type, and clinical follow-up. We identified 66 patients with disease metastatic to the pancreas for which cytologic material was available: 38 (58%) men and 28 (42%) women, with an average age of 63 years (range, 40-89 years). Most metastases (98%) were single lesions, and nearly half were located in the head of the pancreas (30/66). The most common site of origin for these metastases was kidney (27 [41%] cases). Follow-up information was available for 65 (98%) patients, and duration of follow-up ranged from <1 to 10 years (mean, 2.3 years). Thirty-three patients (50%) were alive at the time of the most recent follow-up contact. Of the 25 patients with metastatic renal cell carcinoma, clear cell type, 19 (76%) were alive at the time of the most recent follow-up. It was concluded that metastases may mimic primary pancreatic carcinomas both clinically and cytologically. Ancillary studies in conjunction with clinical history are necessary for the accurate diagnosis of FNAs of secondary pancreatic tumors.
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Affiliation(s)
- Lindsay Waters
- Department of Pathology and Laboratory Medicine, Section of Cytopathology, The University of Texas MD Anderson Cancer Center and Department of Pathology and Genomic Medicine The Methodist Hospital, Houston, Texas
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Okamoto H, Hara Y, Chin M, Hagiwara M, Onodera Y, Horii S, Shirahata Y, Kamei T, Hashizume E, Ohuchi N. An extremely rare case of pancreatic metastasis of esophageal squamous cell carcinoma. World J Gastroenterol 2014; 20:593-597. [PMID: 24574730 PMCID: PMC3923036 DOI: 10.3748/wjg.v20.i2.593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/19/2013] [Indexed: 02/06/2023] Open
Abstract
We report a rare case of a 68-year-old male with metachronous pancreatic metastasis that was resected 2 years after salvage esophagectomy for local recurrence of esophageal squamous cell carcinoma (ESCC). Two years and 8 mo ago, he had undergone definitive chemoradiotherapy for the lower thoracic ESCC and achieved a complete response. Chemoradiotherapy used the protocol of the Japan Clinical Oncology Group trial 9906. Approximately 8 mo later, he developed a local recurrence of the ESCC and underwent thoracoscopic salvage esophagectomy followed by reconstruction with a conduit colon graft via a subcutaneous route. Recently, a tumor of the pancreatic body was found on routine follow-up computed tomography (CT). The tumor diameter was 15 mm on CT, and the maximum standardized uptake value of the lesion was 5.49 at 18F-2-fluoro-2-deoxy-D-glucose positron-emission tomography, strongly suggesting pancreatic cancer. In addition, all tumor markers were within the reference intervals. Therefore, distal pancreatectomy was performed with the resultant histological diagnosis being confirmed as pancreatic metastasis of the ESCC. He was treated with adjuvant chemotherapy, and there has been no evidence of recurrence 9 mo after the surgery. Resection of pancreatic metastasis offers a good prognosis and should be considered for solitary ESCC metastasis.
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A case report: pancreatic squamous cell carcinoma with effective response by S-1 therapy. Clin J Gastroenterol 2014; 7:79-83. [DOI: 10.1007/s12328-013-0449-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
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Hoshino Y, Shinozaki H, Kimura Y, Masugi Y, Ito H, Terauchi T, Kimata M, Furukawa J, Kobayashi K, Ogata Y. Pancreatic metastases from renal cell carcinoma: a case report and literature review of the clinical and radiological characteristics. World J Surg Oncol 2013; 11:289. [PMID: 24209713 PMCID: PMC3835140 DOI: 10.1186/1477-7819-11-289] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 10/25/2013] [Indexed: 01/02/2023] Open
Abstract
Metastatic pancreatic cancer is rare, accounting for approximately 2% of all pancreatic malignancies, and most cases arise from renal cell carcinoma. We report the case of a 63-year-old woman, who presented with a pancreatic tumor detected during her annual health examination. She had undergone left nephrectomy 13 years previously for renal cell carcinoma. Computed tomography (CT) revealed two tumors in the head and body of the pancreas, a hypervascular tumor and a hypovascular tumor with an enhanced rim, respectively. She underwent pylorus-preserving pancreaticoduodenectomy, and metastatic pancreatic tumors arising from the kidney with clustered clear cell carcinoma immunohistochemically positive for CD10 were diagnosed. This report presents the different enhancement features of different lesions on CT scans. Because the enhancement features of lesions have been reported to vary according to the size of the metastatic tumor, a knowledge of the history of renal cell carcinoma is crucial for diagnosis.
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Affiliation(s)
- Yoshinori Hoshino
- Department of Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya 321-0974, Japan.
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