To investigate the heterogeneity of hematogenous metastases of pancreatic ductal carcinomas, we investigated carcinomatous spread in 130 autopsy cases. Hepatic metastases occurred most frequently, in 8 1 cases (62%), which may be explained by the fact that all veins draining the pancreas flow into the portal system. We closely examined the 49 cases without hepatic metastases. Sixteen patients had pulmonary metastases without hepatic metastases, whereas seven had peculiar hematogenous metastases without hepatic or pulmonary metastases. Fifteen of these 23 patients had pancreatic body carcinomas. The unusual patterns of spread might be due to (a) hepatofugal portosystemic shunting induced by splenic vein obstruction, (b) retrograde lymphatic infiltration from metastatic tracheobronchial lymph nodes, or (c) aggressive characteristics of the tumors indicated by peculiar histologic features such as pleomorphic or mucoepidermoid carcinoma, etc. Sixteen patients showed only lymph node metastases and 10 had no distant metastases. Seventeen of these 26 cases had pancreatic head carcinoma. Histologically, two patients had mucinous cystadenocarcinomas, and six had adenocarcinomas producing rich mucin. The average age of the group with no distant metastases was higher. Key Words: Hematogenous metastasis-Pancreatic carcinomaHeterogeneity.Despite many recent advances in the clinical diagnosis and treatment of carcinoma, pancreatic carcinoma remains one of the gravest of medical and surgical problems. This may be attributable to the late onset of symptoms and early metastases, which show a variety of growth patterns. The most common site for hematogenous metastatic lesions in pancreatic carcinoma is the liver, irrespective of the tumor location in the pancreas. However, few detailed studies have examined factors associated with pancreatic carcinoma with extrahepatic metastases. In this study, we focused on 49 autopsy cases with proven pancreatic carcinoma showing no or extrahepatic hematogenous metastases in an effort to identify features of these patients. MATERIALS AND METHODSThe study included 130 autopsy cases of patients with histologically confirmed pancreatic ductal carcinoma. The subjects consisted of 80 men and 50 women, with a mean age of 66.4 years. The primary tumor locations, therapeutic interventions, and histological classification applying the General Rules for Cancers ofthe Pancreas (1) are listed in Table 1 .The modes of carcinomatous spread determined at autopsy were classified into two groups applying the criteria listed in Table 2. Small metastatic lesions that could be detected only histologically were excluded. RESULTSHematogenous metastases associated with pancreatic carcinoma (Table 3) The organs demonstrating metastatic lesions were, in order of frequency, the liver (62%), the lung (55%), and bone (25%). In many instances, hepatic metastases were accompanied by pulmonary 345
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