Cutaneous Metastasis of Pancreatic Adenocarcinoma Following Kidney Transplanation: A Case Report and Review of the Literature

Abstract

Purpose: Pancreatic cancer is one of the most lethal human cancers. Each year in the United States, about 42,470 individuals are diagnosed with this condition and 35,240 die from the disease. 80-90% of pancreatic cancers are diagnosed at the locally advanced or metastatic stage, but cutaneous metastases are extremely rare. If cutaneous metastasis does occur, it is often near the umbilicus, known as the Sister Mary Joseph's nodule. Non-umbilical cutaneous metastases are exceptionally rare, with only several cases reported. Our purpose is to introduce the first reported case of a cutaneous metastatic lesion of pancreatic adenocarcinoma following the transplantation of an organ. We also performed a literature review and analysis of reported cases of non-umbilical cutaneous metastases from pancreatic adenocarcinoma. Methods: In addition to our case report, we performed a MEDLINE and Pubmed search of all reported non-umbilical cutaneous metastases of pancreatic adenocarcinoma followed by a literature review and analysis. Results: Our case involved a 76-year-old female who developed cutaneous pancreatic adenocarcinoma metastases in her surgical wound two years after a bilateral kidney transplant. Three months ago, she noticed symptoms of weight loss, fatigue, and a 4cm lesion in her transplant incision.(Figure 1) A CT scan revealed a mass in the tail of her pancreas and a biopsy of the lesion was positive for adenocarcinoma. She is currently undergoing chemotherapy. A review of the current literature revealed 13 cases of non-umbilical cutaneous metastases from pancreatic adenocarcinoma and five cutaneous metastases to the FNA biopsy site. One report noted metastasis to an incisional site following surgery, but none reported metastasis following organ transplantation (Table 1).Figure: Metastatic lesion of pancreatic adenocarcinoma.Table 1: All reported cases of non-umbilical cutaneous metastases of pancreatic adenocarcinomaConclusion: The death rate from cancer has increased as the general population has aged. This also holds true for transplant recipients. Some believe that cancer will soon surpass cardiovascular disease as the major cause of mortality after transplant. Therefore, it is incumbent upon us to appropriately screen patients with age appropriate evidenced based examinations. Additionally, those patients with suspicious presentations should be judiciously evaluated in order to discover a cancer as quickly as possible.