Case Of Pancreatic Metastasis Research Articles

Pankreatomia jako forma leczenia przerzutu mięśniakomięsaka gładkokomórkowego- opis przypadku i przegląd literatury

Background: Pancreatic cancers represent about 2% of all malignant tumors. The prognosis for patients is rather poor and the five-year survival is only 9%. Metastases constitute 2–5% of this organ’s tumors, and the management of such cases is determined individually depending on the type of cancer, the patient’s condition and the medical center’s experience. We present a rare case of pancreatic metastasis from a subcutaneous leiomyosarcoma. Case: A 71-year-old woman with history of leiomyosarcoma — six years ago, two cancer outbreaks, located in the subcutaneous tissue of the thigh and shoulder treated by surgery and adjuvant radiotherapy. After 5 years, a lung metastasis was diagnosed and successfully resected. The following year, CT scan revealed a mass in the pancreas. The patient also complained of epigastric pain and bloating. The biopsy of the lesion confirmed leiomyosarcoma metastasis. The patient underwent 6 cycles of ADIC chemotherapy, after which the tumor size decreased and the laparotomy was performed. The metastasis was well-demarcated and did not infiltrate surrounding tissues, so distal pancreatectomy provided a complete tumor resection There were no complications throughout surgery During 12 months follow up no recurrence was observed. Conclusions: Due to the relatively rare occurrence, standards for the treatment of pancreatic metastases have not been developed yet. This case shows that treatment by resection of the tumor while maintaining a surgical margin can be considered as a form of treatment in pancreatic secondary cancers.

Pancreatic FDG uptake on follow-up PET/CT in patients with cancer.

To evaluate the breakdown of unexpected pancreatic 18F-fluorodeoxyglucose (FDG) uptake and the proportion of secondary primary pancreatic cancer on follow-up, patients with cancer underwent positron emission tomography/computed tomography (PET/CT). The participants consisted of 4,473 consecutive patients with cancer who underwent follow-up PET/CT between January 2015 and March 2019 at Kochi Medical School. Among the participants, 225 with a history of pancreatic cancer were excluded from the present study. Retrospective and blinded PET/CT evaluations of 4,248 patients were performed. In patients with pancreatic FDG uptake, the distribution of FDG uptake in the pancreas was evaluated. The final diagnosis was determined pathologically. A total of 14 (0.3%) of the 4,248 patients exhibited FDG uptake in the pancreatic area. Pancreatic abnormalities were detected in 14 patients, and included five cases of pancreatic metastases (36%), four cases of secondary primary pancreatic cancer (29%), two cases of lymph node metastases (14%), one case of malignant lymphoma (7%), one case of autoimmune pancreatitis (7%) and one case of pseudolesion (7%). One patient with early-stage secondary primary pancreatic cancer had a maximum standardized uptake value (SUVmax) <3.0. The remaining 13 patients had a SUVmax >3.0 in the pancreas. Of the 14 patients, two had multiple foci of FDG uptake in the pancreas. Patients with multiple foci of FDG uptake exhibited pancreatic metastasis from renal cell carcinoma and malignant lymphoma. In conclusion, the majority of patients with unexpected pancreatic FDG uptake on follow-up PET/CT exhibited malignancies; furthermore, ~30% of the malignancies detected in patients with pancreatic FDG uptake were secondary primary pancreatic cancers. In patients with unexpected pancreatic FDG uptake on follow-up PET/CT, primary cancer should be considered as well as metastatic tumors.

A Case of Distal Pancreatectomy for Pancreatic Metastasis of Thymic Atypical Carcinoid

Background: Thymic atypical carcinoid(AC) tends to have a more aggressive clinical course than typical carcinoid(TC). About 20%-30% of patients with thymic AC experience local recurrence or distant metastasis. Pancreatic metastasis of thymic AC is extremely infrequent. We experienced a case of pancreatic metastasis of thymic atypical carcinoid, in which a distal pancreatectomy was performed. Case presentation: A 50-year-old man underwent thoracoscopic resection of a mediastinal tumor in June 2009. The diagnosis was thymic AC. He also underwent an extended thymectomy in October 2011, thoracoscopic resection in October 2012, and tumor resection of the chest wall in March 2013 for recurrences. During follow up in April 2014, computed tomography (CT) revealed lymph node swelling on the ventral side of the brachiocephalic vein, around the left gastric vein, and on the left side of the celiac artery. Dynamic CT revealed a pancreatic tumor 10 mm in diameter with low enhancement. EUS-guided fine-needle aspiration (EUS-FNA) biopsy revealed the pancreatic tumor was compatible with metastasis of thymic AC. The patient underwent abdominal lymph node resection and distal pancreatectomy in June 2014. Because the lymph node on the ventral side of the branchiocephalic vein was judged as unresectable, 60-Gy radiation therapy was given in September 2014. Per pathological examination and immunohistochemistry, the final diagnosis was pancreatic metastasis of thymic AC. With several chemotherapy courses for recurrences, the patient has remained alive for eight years after the first surgery. Conclusion: AC metastasis to the pancreas is extremely rare. EUS-FNA is useful for diagnosis. Definitive determination of whether the treatment provides a survival benefit awaits further studies.

A Case of Pancreatic Metastasis from Renal Cell Carcinoma 12 Years after Resection of the Primary Tumor

A Case of Pancreatic Metastasis from Renal Cell Carcinoma 12 Years after Resection of the Primary Tumor

The Value of MRI in Diagnosis of Solid Pancreatic Tumors

Aim: To investigate the value of 3.0 T MRI in the diagnosis of solid pancreatic tumor. Materials and Methods: Aggregate of 36 patients were enlisted with suspected or proven as solid pancreatic tumors were collected from the first affiliated Hospital of Anhui Medical University Teaching Hospital during the period of January 2012 to August 2015, contained 20 cases of pancreatic adenocarcinoma, 7 cases of pancreatic neuroendocrine tumors (PNETs), 5 cases of pancreatic metastases, 4 cases of solid pseudopapillary tumors (SPTP). All the patients performed with plain scan and multiphasic contrast enhanced imaging on 3.0 T MR, 23 cases performed with MRCP. The data of clinic and imaging were retrospectively analyzed. Results: Pancreatic adenocarcinoma was irregular in shape, lesion was hypo intense in 10 cases, slightly hypo intense in 9 cases and isointense in one case on T1WI. 10 tumor showed slightly enhancement in arterial phase, and all of tumors showed moderate enhancement during portal and delayed phase; 19 cases showed double duct sign, and one case showed distal pancreatic duct dilation. Of the 7 cases with PNETs, the margin was well defined in six well differentiated lesions and ill-defined in one pancreatic neuroendocrine carcinoma; six tumors were marked enhancement in arterial phase and one tumor was moderate enhancement in pancreatic parenchyma in all of three phases. The mean diameter of SPTP was 5.2 cm. The solid part of tumors was hyperintense on T1WI and slightly hyper intense on T2WI, with progressively enhancement. 4 SPTPs had capsule which were hyperintense on T1WI and T2WI exhibited moderate enhancement. Of the 5 pancreatic metastases, one cases had only one lesion, two cases had multiple lesions and two cases showed diffuse pancreatic enlargement, one case showed heterogenous slightly enhancement, two case showed peripheral rim enhancement, two case showed marked enhancement in arterial, then wash-out in delayed and portal phases. Conclusion: MRI is valuable for diagnosis and distinguishing solid pancreatic tumors.

術後26年目に膵転移を来しEUS-FNAにて診断した腎細胞癌の1例

症例は81歳，男性．25年前に腎細胞癌にて右腎摘出術の既往があった．腹部超音波検査にて膵頭部腫瘤が指摘され精査目的に入院となった．腹部造影CT検査では膵頭部から膵体部に一塊となった複数の多血性腫瘤を認め，肝内にも同様の造影効果を有する腫瘤を多数認めた．画像検査から膵内分泌腫瘍または腎癌膵転移を疑い，治療方針決定のために超音波内視鏡下穿刺吸引術（EUS-FNA）を施行した．25G穿刺針を用いて穿刺し，セルブック法にて検体処理を行い，免疫組織染色による病理組織診断により腎細胞癌膵転移と診断した．腎細胞癌は，切除から長期経過した後に異時性転移を来す場合があり，膵の多血性腫瘤の鑑別の一つとして考慮する必要がある．多血性膵腫瘤に対し，細径の穿刺針にてEUS-FNAを行い，セルブロック法による免疫組織染色が診断に有用であった術後26年目に膵転移を来した腎細胞癌の1例を経験したので報告する．

A case of pancreatic metastasis from squamous cell carcinoma of the lung diagnosed by a new EUS-guided fine needle biopsy system

A case of pancreatic metastasis from squamous cell carcinoma of the lung diagnosed by a new EUS-guided fine needle biopsy system

A surgical case of pancreatic metastasis from lung cancer

A surgical case of pancreatic metastasis from lung cancer

A case of pancreatic metastasis 18 years after a renal cell carcinoma operation

A case of pancreatic metastasis 18 years after a renal cell carcinoma operation

膵頭十二指腸切除術を行った乳癌術後膵頭部転移の1例

膵頭十二指腸切除術を行った乳癌術後膵頭部転移の1例

Strategic Approach to the Splenic Artery in Laparoscopic Spleen-preserving Distal Pancreatectomy.

Background:Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is an ideal procedure in selected patients with benign or low-grade malignant tumors in the body/tail of the pancreas. We describe our procedure and experience with splenic vessel-preserving LSPDP (SVP-LSPDP) in a retrospective case series.Methods:Six consecutive patients underwent SVP-LSPDP from January 2011 to September 2013. We evaluated the courses of the splenic artery by preoperative computed tomography and applied an individualized approach (the superior approach or inferior approach) to the splenic artery.Results:All of the operations were successful. The median surgical duration was 249 minutes. The median blood loss was 0 mL. Pathologic examination revealed 4 cases of insulinoma, 1 case of solid pseudopapillary tumor, and 1 case of pancreatic metastasis from renal carcinoma.Conclusions:In performing SVP-LSPDP, it is effective to make a strategic choice between 2 different approaches according to the course of splenic artery.

A Case of Pancreatic Metastasis From a Papillary Thyroid Carcinoma Mimicking Pancreatic Cancer

Papillary thyroid cancer (PTC) has a good prognosis and a low incidence of distant metastases. It is extremely rare for PTC to metastasize to the pancreas. Only five cases have been previously reported worldwide. Most cases are discovered incidentally by abdominal computed tomography (CT) or positron emission tomography-CT (PET-CT) during follow-up studies after thyroidectomies. Pancreatic metastasis of PTC is usually unidentifiable by a whole-body I131 scan, a common follow-up modality. When a pancreatic mass is found in patients with PTC, it must be differentiated from pancreatic cancer. In previous reports, patients with pancreatic metastases of PTC underwent operations for therapeutic diagnosis or underwent fine needle aspiration biopsies (FNAB). However, it is unclear whether the benefit of an operation outweighs the risk. We experienced a case of PTC with pancreatic metastasis that was found on PET-CT. Contrast-enhanced endoscopic ultrasonography (EUS) was performed to evaluate the characteristics of the pancreatic mass and pathological confirmation was obtained cytologically via EUS-FNA. (Korean J Med 2014;87:187-192)

腎細胞癌膵転移の２切除例

腎細胞癌膵転移の２切除例

Application of contrast-enhanced ultrasound in the diagnosis of solid pancreatic lesions—A comparison of conventional ultrasound and contrast-enhanced CT

ObjectiveTo explore the diagnostic value of contrast-enhanced ultrasound (CEUS) by comparison with conventional ultrasound (US) and contrast-enhanced CT (CECT) in solid pancreatic lesions. MethodNinety patients with solid pancreatic focal lesions were enrolled, including 36 cases of pancreatic carcinoma, 28 cases of pancreatitis, 6 cases of pancreatic neuroendocrine tumor, 12 cases of solid pseudopapillary tumor of the pancreas, 6 cases of pancreatic metastases, 1 case of cavernous hemolymphangioma and 1 case of lymphoma. US and CEUS were applied respectively for the diagnosis of a total of 90 cases of solid pancreatic lesions. The diagnostic results were scored on a 5-point scale. Results of CEUS were compared with CECT. Results(1) 3-score cases (undetermined) diagnosed by CEUS were obviously fewer than that of US, while the number of 1-score (definitely benign) and 5-score (definitely malignant) cases diagnosed by CEUS was significantly more than that of US. There was a significant difference in the distribution of final scores using the two methods (p<0.001). The overall diagnostic accuracies of the 90 cases for CEUS and US were 83.33% and 44.44%, respectively, which indicated an obvious advantage for CEUS (p<0.001). (2) The diagnostic consistency among three ultrasound doctors: the kappa values calculated for US were 0.537, 0.444 and 0.525, compared with 0.748, 0.645 and 0.795 for CEUS. The interobserver agreement for CEUS was higher than that for US. (3) The sensitivity, specificity and accuracy of the diagnosis of pancreatic carcinoma with CEUS and CECT were 91.7% and 97.2%, 87.0% and 88.9%, and 88.9% and 92.2%, respectively, while for the diagnosis of pancreatitis, the corresponding indices were 82.1% and 67.9%, 91.9% and 100%, and 88.9% and 90%, respectively, showing no significant differences (p>0.05). ConclusionCEUS has obvious superiority over conventional US in the general diagnostic accuracy of solid pancreatic lesions and in the diagnostic consistency among doctors. The performances of CEUS are similar to that of CECT in the diagnosis of pancreatic carcinoma and focal pancreatitis.

A Resectable Pancreatic Metastasis from Pulmonary Adenocarcinoma

A 67-year-old man, diagnosed as primary pulmonary adenocarcinoma by intraoperative fine-needle aspiration biopsy cytology, underwent right lower lobectomy with radical lymphadenectomy. The pathological stage was Stage IIA (pT1bN1M0, N-reason: 12L positive). After surgery, nodular shadows without intrathoracic lymph node or distant metastasis were demonstrated metachronously three times by follow-up CT. Wedge resection was performed for each of the tumors, and the pathological diagnosis in each case was primary pulmonary adenocarcinoma, Stage IA (T1b), IA (T1a) and IA (T1a), respectively. Five years after the initial pulmonary resection, a follow-up abdominal CT revealed a20-mm nodular shadow. We suspected that this pancreatic tumor might be a primary rather than metastatic one, therefore, pancreatoduodenectomy was performed. Pathological examination revealed adenocarcinoma that was positive for thyroid transcription factor (TTF)-1, allowing a final diagnosis of metastatic pulmonary adenocarcinoma.This case is very rare, because most cases of pancreatic metastasis from lung cancer have already widespread disease at the time of diagnosis.This case illustrates that pancreatic metastasis from pulmonary adenocarcinoma should be borne in mind, even if the pancreatic tumor is a solitary lesion without additional organ metastasis.

A Case of Pancreatic Metastases from a Papillary Thyroid Carcinoma Diagnosed by Hemorrhagic Shock Originating from a Retroperitoneal Hematoma

A Case of Pancreatic Metastases from a Papillary Thyroid Carcinoma Diagnosed by Hemorrhagic Shock Originating from a Retroperitoneal Hematoma

大腸癌術後膵転移の1例

悪性腫瘍の膵転移は予後不良との報告があるが，膵切除後の長期生存例も報告されている．大腸癌術後に肝細胞癌を発症し，その後，転移性膵癌を指摘され尾側膵切除術を行った症例を経験したので報告する．症例は75歳女性で，S状結腸癌術後5年目にCTで膵尾部に造影効果を示さない単発の腫瘤が指摘された．膵腫瘤の辺縁は比較的明瞭で，周囲への浸潤はなかった．MRCPで主膵管の途絶や尾側膵管の拡張はなく，膵原発より転移性膵腫瘍が疑われた．尾側膵切除および脾合併切除術を行い，大腸癌膵転移であった．術後10カ月目に多発肺転移が認められたが，化学療法を行っており術後25カ月現在生存中である．悪性腫瘍膵転移の予後は原発巣によるところが大きいと考えられるが，大腸癌膵転移切除症例はまだ報告数が少ないものの比較的長期生存例も報告されている．耐術能があり他臓器に切除不能病変がなければ，膵切除術は十分考慮されるべきものと考えられる．

Pancreaticoduodenectomy for Pancreatic Metastases of Malignant Fibrous Histiocytoma

Unlike primary pancreatic carcinoma, metastases to the pancreas are rare and their resection may be performed as a palliative treatment due to poorly defined outcome. We herein present an extremely rare case of pancreatic metastases of malignant fibrous histiocytoma (MFH) undergoing pancreaticoduodenectomy with tumor-free survival within postoperative 35-month follow-up. Pancreatic resection for metastatic MFH to the pancreas should be considered in selected patients. Long-term survival or good palliation may be achieved.

大腸癌術後膵転移の1例

大腸癌術後膵転移の1例

消化管出血を契機に発見された腎癌術後膵転移の一例

消化管出血を契機に発見された腎癌術後膵転移の一例