Pancreatic metastasis from gastric carcinoma: a case report
© Wente et al; licensee BioMed Central Ltd. 2004
Received: 18 September 2004
Accepted: 07 December 2004
Published: 07 December 2004
The pancreas is a rare but occasionally favored target for metastasis. Metastatic lesions in the pancreas have been described for various primary cancers, such as carcinomas of the lung, the breast, renal cell carcinoma and sarcomas.
We report the case of a 60-year old female with a mass in the pancreatic head four years after partial gastrectomy for gastric adenocarcinoma. The patient underwent a pancreatoduodenectomy. Pathological examination revealed metastases of the primary gastric carcinoma within the pancreatic head and in regional lymph nodes.
Pancreatic tumors in patients with a history of non-pancreatic malignancy should always be considered to be a putative metastatic lesion at an unusual site. If the pancreas can be identified as the only site of spread, radical resection may prolong survival.
The pancreas is an uncommon location for solitary metastasis from other primary cancers . Despite this, in large autopsy series the prevalence of pancreatic metastasis has been described to be as high as 6% to 11% . Whereas renal cell carcinoma appears to be the most common primary tumor to cause secondary pancreatic tumors, a variety of other cancers may spread to the pancreas, such as colon cancer, non-small cell lung cancer, and sarcomas . This article presents the case of a pancreatic metastasis presenting as first site of gastric cancer recurrence four years after primary diagnosis.
The patient was discharged from the hospital without any perioperative morbidity on the ninth postoperative day. The postoperative blood levels of the tumor markers declined to normal values (CEA 2.6 μg/l, CA 19-9 24 U/ml). Due to the complete surgical resection and the lack of risk factors for recurrence, the patient received no further adjuvant therapy. Under regular follow-up for one year with determination of the tumor markers and computed tomography, the patient revealed no signs or symptoms of local or systemic recurrence.
Death from recurrence of gastric adenocarcinoma occurs in 70–75% of patients during the first two years after surgical intervention, however, reports of recurrences more than 10 years after primary diagnosis have been reported as well . The most frequent sites of tumor recurrences include local, regional and peripheral lymph nodes, as well as the liver, the lungs, and the peritoneum . Furthermore, solitary metastasis in other organs, such as the thyroid gland or the spleen have been described [6, 7]. In contrast to direct infiltration into the pancreas, metastases of gastric cancer into the pancreas are considered to be extremely rare and to our knowledge only four cases have been reported in the English literature [8–10].
Adenocarcinomas of the pancreas and of other primary sites frequently display a large histomorphological and immunohistochemical overlap. Thus the differential diagnosis of primary pancreatic cancer versus solitary metastases of other adenocarcinomas may be very difficult – if not impossible – using common pathological and immunohistochemical techniques. According to Robbins et al , solitary pancreatic masses can be classified as secondary tumors to the pancreas in only 2% of the cases, and they are frequently misdiagnosed as primary pancreatic cancers. As a consequence from this, the subtle diagnostic work-up for isolated masses in the pancreas needs to inherit a meticulous elaboration of the medical history of the patients, in particular focused on previous non-pancreatic malignancy.
Pancreatic resections can nowadays be performed with low morbidity and mortality rates, in particular in high-volume centers [11, 12]. Results of surgical extirpation of isolated metastases to the pancreas from various primary tumors provide improvement with regard to long-term survival [1, 2]. Therefore, a resection of isolated metastases in the pancreas should be considered as a treatment option in patients with the history of non-pancreatic malignancy .
Written consent was obtained from the patient for publication of this case.
- Hiotis SP, Klimstra DS, Conlon KC, Brennan MF: Results after pancreatic resection for metastatic lesions. Ann Surg Oncol. 2002, 9: 675-679. 10.1245/aso.2002.9.7.675.View ArticlePubMedGoogle Scholar
- Z'graggen K, Fernandez-del Castillo C, Rattner DW, Sigala H, Warshaw AL: Metastases to the pancreas and their surgical extirpation. Arch Surg. 1998, 133: 413-417. 10.1001/archsurg.133.4.413.View ArticlePubMedGoogle Scholar
- Robbins EG, Franceschi D, Barkin JS: Solitary metastatic tumors to the pancreas: a case report and review of the literature. Am J Gastroenterol. 1996, 91: 2414-2417.PubMedGoogle Scholar
- Shiraishi N, Inomata M, Osawa N, Yasuda K, Adachi Y, Kitano S: Early and late recurrence after gastrectomy for gastric carcinoma. Univariate and multivariate analyses. Cancer. 2000, 89: 255-261. 10.1002/1097-0142(20000715)89:2<255::AID-CNCR8>3.0.CO;2-N.View ArticlePubMedGoogle Scholar
- Ushijima T, Sasako M: Focus on gastric cancer. Cancer Cell. 2004, 5: 121-125. 10.1016/S1535-6108(04)00033-9.View ArticlePubMedGoogle Scholar
- Ok E, Sozuer E: Thyroid metastasis from gastric carcinoma: report of a case. Surg Today. 2000, 30: 1005-1007. 10.1007/s005950070021.View ArticlePubMedGoogle Scholar
- Yamanouchi K, Ikematsu Y, Waki S, Kida H, Nishiwaki Y, Gotoh K, Ozawa T, Uchimura M: Solitary splenic metastasis from gastric cancer: report of a case. Surg Today. 2002, 32: 1081-1084. 10.1007/s005950200218.View ArticlePubMedGoogle Scholar
- Brannigan AE, Kerin MJ, O'Keane JC, McEntee GP: Isolated resectable pancreatic metastasis 10 years post gastrectomy. Ir J Med Sci. 2000, 169: 227-View ArticlePubMedGoogle Scholar
- Nakai T, Shimomura T, Nakai H: A case of isolated pancreatic metastasis of gastric cancer presenting problematic discrimination from gastropancreatic double cancer. Hepatogastroenterology. 2004, 51: 1571-1574.PubMedGoogle Scholar
- Roland CF, van Heerden JA: Nonpancreatic primary tumors with metastasis to the pancreas. Surg Gynecol Obstet. 1989, 168: 345-347.PubMedGoogle Scholar
- Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE: Hospital volume and surgical mortality in the United States. N Engl J Med. 2002, 346: 1128-1137. 10.1056/NEJMsa012337.View ArticlePubMedGoogle Scholar
- Büchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z'graggen K: Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003, 138: 1310-1314. 10.1001/archsurg.138.12.1310.View ArticlePubMedGoogle Scholar
- Sperti C, Pasquali C, Liessi G, Pinciroli L, Decet G, Pedrazzoli S: Pancreatic resection for metastatic tumors to the pancreas. J Surg Oncol. 2003, 83: 161-166. 10.1002/jso.10262.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.