Pancreatic Adenocarcinoma With Rare Sigmoid Colon Metastasis

Metastatic pancreatic cancer with multiple metastases confined to the large intestine: a case report and literature review

The incidence and mortality rate of pancreatic cancer are increasing worldwide. Regional lymph nodes, liver, lung, and peritoneum are common sites of metastasis from pancreatic cancer, but the gastrointestinal tract is rare as a metastatic organ from pancreatic cancer. An 80-year-old man was referred to our department for a hypovascular pancreatic mass on contrast-enhanced computed tomography (CECT). Endoscopic ultrasound-guided fine needle aspiration revealed adenocarcinoma, and he was diagnosed with pancreatic cancer. No lymph nodes or distant metastases were detected by either CECT or gadolinium-enhanced magnetic resonance imaging, and we evaluated this case as borderline resectable. However, total colonoscopy for positive fecal occult blood tests revealed a reddish and hemorrhagic mucosal thickening in the ascending and sigmoid colon and rectum, which was inconsistent with primary colorectal cancer. Biopsy specimens from these sites revealed cytokeratin (CK)7-positive and CK20- and CDX2-negative adenocarcinoma, consistent with cancer of pancreatic origin. The patient underwent palliative chemotherapy with gemcitabine but died from COVID-19 infection eight months after diagnosis. Performing total colonoscopy as a preoperative screening is important for accurate cancer staging of patients with possible resectable pancreatic cancer.

Pancreatic Carcinoma Causing Schnitzler's Metastasis

Schnitzler's metastasis occurs due to the deposition of the tumor cells in the submucosa of the rectum, leading to rectal stenosis. We present a 60-year-old female who presented with abdominal pain, distension, and vomiting. Abdominal examination showed a distended abdomen and palpable bowel loops, and per rectal examination showed rectal stenosis. Imaging studies suggest rectal stenosis with carcinoma of the pancreas head. The patient was diagnosed with Schnitzler's metastasis with carcinoma of the pancreas head, which has not been reported in the literature. The patient underwent a diversion sigmoid colostomy and was planned for palliative chemotherapy after stenting the common bile duct.

A Rare Case of Pancreatic Adenocarcinoma With Incidental Synchronous Hepatic and Sigmoid Colonic Metastasis: A Case Report and Literature Review

Metastasis of pancreatic adenocarcinoma to the colon is a very rare condition that might be underdiagnosed and underreported in the literature. We report a very rare case of incidental findings of sigmoid metastasis secondary to pancreatic adenocarcinoma in a 60-year-old Saudi male, who is a non-smoker with a normal medical and surgical history. The patient presented to a primary care clinic with abdominal bloating and vague on/off abdominal pain for almost 1 year as well as unintentional weight loss without lower gastrointestinal (GI) symptoms. After the case was discussed in the multidisciplinary tumor board, the patient was started on systematic palliative chemotherapy. However, after receiving the first cycle, he started to deteriorate rapidly and succumbed to secondary cardiopulmonary arrest. Cases of synchronous metastasis of pancreatic adenocarcinoma to the colon might not be well known or common. However, a high index of suspicion and individualizing the workup tools may need to be used.

Beware the pancreatic incidentaloma in colorectal tumours: pancreatic adenocarcinoma with metastases to the colon and rectum

Colorectal cancer (CRC) is the third most diagnosed malignancy in the Western world. Routine staging of CRC often identifies incidental lesions on cross-sectional imaging. Appropriate treatment is dependent on a correct histological diagnosis. Pancreatic Ductal Adenocarcinoma (PDAC) is a rarer and often devastating diagnosis for which the treatment pathway differs significantly to CRC. We report two rare cases: the first recorded case of PDAC with synchronous rectal metastasis and a case of an acute presentation with large bowel obstruction from synchronous colonic metastasis. Both cases presented a significant diagnostic challenge. The management of both cases would have been altered had the histological diagnosis been known prior to surgery. Clinicians treating CRC should be wary of incidental lesions on staging investigations as they rarely represent an occult extra-intestinal primary malignancy. Immunohistochemistry plays an important role in ascertaining the origin of gastrointestinal malignancy.

Pancreatic cancer presenting as bowel obstruction and role of next generation sequencing: A case report

Introduction and importance

Pancreatic adenocarcinoma is one of the leading causes of death. Presentation with colonic metastases is far less frequently reported in the literature and may be misdiagnosed as colonic adenocarcinoma. We report the case of a female patient with metastatic pancreatic adenocarcinoma that presented with a sigmoid obstruction.

Case presentation

A 66-year-old female presented with constipation and abdominal pain. She was found to have an obstructing sigmoid colon lesion, multiple metastatic lesions in the liver, and a pancreatic tail lesion. She underwent left hemicolectomy and ostomy placement. The gross pathology of the colon and needle biopsy of the liver was consistent of pancreatobiliary origin. Genomic screening performed, patient found to be KRAS G12R mutated. She was given one cycle of chemotherapy, thereafter was referred to hospice care.

Clinical discussion

Primary metastatic pancreatic cancer is now the 2nd most diagnosed cancer in the United States after lung cancer. The prognosis for the malignancy is poor, patients are usually diagnosed late at the time that the tumor has metastasized to other organs. Colonic metastasis is a rarely seen and far less frequently reported in the literature. Next-generation-sequencing was performed at baseline to further characterize her tumor for any actionable mutations.

Conclusion

Pancreatic adenocarcinoma is an aggressive malignancy with a poor prognosis. Next-generation-sequencing may offer targeted therapy if an actionable mutation is present such as our patient's, however due to late diagnosis, rapid clinical deterioration, and next-generation sequencing delay we were unable to alter the patient's outcome.

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Colonic obstruction is a rare presentation of metastatic pancreatic adenocarcinoma.

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Next-generation sequencing may offer therapies if patient has a targetable mutation.

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Pancreas cancer is limited in treatment, NGS may offer better outcome if targetable.

Pancreatic cancer with synchronous liver and colon metastases: A case report

BACKGROUND

Metastasis of pancreatic cancer to the colon is rare and the features need to be further elucidated. Herein, we report a rare case of pancreatic cancer with simultaneous liver and colon metastases.

CASE SUMMARY

A 48-year-old man with intrahepatic space-occupying lesions based on a computed tomography scan was admitted to our hospital for further treatment. Abdominal magnetic resonance imaging revealed a 6.4 cm × 4.2 cm mass in the tail of the pancreas and multiple low-density masses in the liver parenchyma. In addition, a mass of 2.2 cm × 1.6 cm with surface congestive erosions in the sigmoid colon was detected by colonoscopy. Histopathological examination of biopsies from both the liver and colon lesions revealed a moderately to poorly differentiated adenocarcinoma. Immunohistochemical staining of the colon tumor was positive for cytokeratin (CK) 7 and CK, but negative for colorectal adenocarcinoma-related markers CK 20, CDX2, and SATB2, thus indicating that the metastasis originated from the pancreas. Next-generation sequencing for genomic profiling of the liver and colon metastases both found mutations in KRAS (p.G12D) and TP53 (c.376-1delG), with microsatellite stable and low tumor mutational burden without actionable or cancer-predisposing gene mutations detected. The patient was subsequently treated with 12 cycles of FOLFIRINOX which led to a sustainable response, followed by ongoing maintenance treatment with irinotecan plus fluorouracil.

CONCLUSION

For this rare case, careful evaluation of histopathological and immunohistochemical staining results are required. The genomic profiling of colon lesions was revealed for the first time, and FOLFIRINOX showed good treatment efficacy in this patient.

Unusual metastasis in BRCA mutated pancreatic cancer while on maintenance Olaparib: Two case reports and review of the literature

The most common metastatic sites of pancreatic cancer are the liver, lymph nodes, peritoneum and lung. Here we report two cases of BRCA mutated pancreatic cancer that developed unusual metastasis while treatment with maintenance Olaparib and leading to rapid death. We hereby review the literature and address the possibility of a different nature and tumour biology of BRCA mutated cancer treated with PARP inhibitors.

Locally Invasive Pancreatic Adenocarcinoma Presenting in the Splenic Flexure: A Rare Case Report

Pancreatic adenocarcinoma is a malignant cancer seen predominantly in males presenting with high-risk factors including chronic pancreatitis, familial history of cancer, and tobacco and alcohol abuse. The etiology of pancreatic adenocarcinoma is deceptive, and research continues to investigate its molecular patterns. Herein, we present a case of a 74-year-old Caucasian male who presented to the emergency department (ED) with tarry stools and hematochezia in the rectum for two weeks. Colonoscopy was terminated prematurely due to a mass at 70 cm within the splenic flexure of the colon. Exploratory laparotomy revealed a palpable mass at the splenic flexure invading the spleen. Splenectomy, distal pancreatoduodenectomy, and left hemicolectomy were performed. Pathological imaging revealed locally invasive pancreatic adenocarcinoma presenting in the splenic flexure, pancreatic parenchyma, peripancreatic soft tissue, and colonic wall. The patient is currently undergoing chemotherapy and radiation treatment. Below, we discuss risk factors, pathology, screening methods, and current treatment guidelines regarding pancreatic cancer. When pancreatic adenocarcinoma becomes metastatic, it most commonly involves the liver and lungs, but the review of current literature shows that limited cases of local invasion to the splenic flexure have been reported.