A case report of pancreatic metastasis from synovial sarcoma successfully treated by metastasectomy with adjuvant chemotherapy

Makino, Yuki; Shigekawa, Minoru; Kegasawa, Tadashi; Suda, Takahiro; Yoshioka, Teppei; Iwahashi, Kiyoshi; Ikezawa, Kenji; Sakamori, Ryotaro; Yakushijin, Takayuki; Kajihara, Jun; Tomimaru, Yoshito; Eguchi, Hidetoshi; Imura, Yoshinori; Outani, Hidetatsu; Naka, Norifumi; Honma, Keiichiro; Morii, Eiichi; Tatsumi, Tomohide; Hiramatsu, Naoki; Takehara, Tetsuo

doi:10.1097/md.0000000000004789

Cited by 11 publications

(22 citation statements)

References 27 publications

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“…The patient reported here was also treated by surgical resection. Our patient and the two patients described by Makino et al [12] are doing well, without recurrence or distant metastasis for 92 months, 40 months, and 30 months after surgical resection, respectively. Solitary fibrous tumors/hemangiopericytomas of the central nervous system (CNS) show two distinct histologic phenotypes, a solitary fibrous tumor phenotype and a hemangiopericytoma phenotype [21].…”

Section: Discussionsupporting

confidence: 64%

“…Synovial sarcoma metastasizes in approximately 50% of cases, and common metastatic sites are the lung and bone [12]. Unlike other sarcomas, spread to the lymph nodes is not infrequent (3%-23%) [12]. For disseminated disease, chemotherapy based on adriamycin and ifosfamide is usually attempted.…”

Section: Discussionmentioning

confidence: 99%

“…For disseminated disease, chemotherapy based on adriamycin and ifosfamide is usually attempted. Makino et al [12] suggested that pancreatic metastasis from synovial sarcoma can be successfully treated by surgical resection in cases of solitary pancreatic lesions with no extra-pancreatic metastasis and a more than 3-year interval between diagnosis of the primary tumor and pancreatic metastasis. Only four cases of metastatic synovial sarcoma to the pancreas have been reported in the literature [5,10,12,20], making our case the fifth.…”

Section: Discussionmentioning

confidence: 99%

“…Intensive whole-body imaging screening is necessary in sarcoma patients, and metastasis should remain a differential diagnosis in pancreatic tumors with sarcomatoid features. Recently, the efficacy of surgical resection of pancreatic metastases was shown for sarcoma [10,[12][13][14][15][16] as well as renal cell carcinoma [4]. Clinicians caring for patients with sarcoma should be aware of the potential for increased survival following surgical resection of the metastasis.…”

Section: Discussionmentioning

confidence: 99%

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Sarcoma metastasis to the pancreas: experience at a single institution

Lee

Song

Hong

et al. 2020

J Pathol Transl Med

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Most pancreatic tumors are primary, and the majority are adenocarcinomas of ductal origin [1,2]. Although direct invasion of the pancreas by adjacent aggressive tumors is often observed, pancreatic metastasis from distant primary sites is very rare [1,3]. Metastatic pancreatic cancer accounts for less than 2% of all pancreatic malignancies [4,5]. Renal cell carcinoma is the most common primary tumor to metastasize to the pancreas [4,5]. Other common tumors are colorectal cancer, melanoma, breast cancer, lung cancer, and sarcoma [4]. Among these, cases of metastatic sarcoma to the pancreas are limited [4]. Metastatic sarcoma to the pancreas may present a diagnostic and therapeutic challenge due to its rarity and the difficulty in distinguishing between primary and metastatic tumors based on their radiologic features, especially for solitary mass [3,6]. Furthermore, tumors located in the body or tail of the pancreas often present with no symptoms [3,7]. Therapeutic approaches can vary greatly between primary pancreatic cancer and metastatic sarcoma [3,4,8-10]. With continued improvements in treatment and survival for sarcoma patients, the frequency of detection of metastasis to unusual sites is increasing [11]. However, the index of suspicion for metastatic sarcoma in the pancreas is still very low, and a standard management regimen for metastatic pancreatic sarcoma has not been established. Prolonged survival after surgery for isolated or resectable pancreatic metastatic sarcoma has been reported [10,12-16]. In this paper, we present 12 cases of metastatic sarcoma to the pancreas and report their clinical and histologic features. MATERIALS AND METHODS One hundred twenty-four cases of metastasis to the pancreas diagnosed by biopsy (n = 49, 39.5%) or surgical resection (n = 75, 60.5%) at Asan Medical Center between 2000 and 2017 were reviewed. Only distant metastatic tumors to the pancreas were included; adjacent tumors directly extending to the pancreas were excluded. Patient medical records were retrospectively reviewed to evaluate clinical presentation, treatment, and patient status. Hematoxylin and eosin-stained slides of both

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sarcoma metastasis to the pancreas: experience at a single institution

Lee

Song

Hong

et al. 2020

J Pathol Transl Med

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“…The prognosis of synovial sarcoma is moderately poor, and distant metastases occur in approximately 50% of patients [ 23 ]. Pancreatic metastasis of synovial sarcoma is extremely rare, and only four cases have been reported to date [ 24 – 27 ]. Furthermore, there are no reports of hemorrhage due to the rupture of pancreatic metastatic tumors in patients with synovial sarcoma.…”

Section: Discussionmentioning

confidence: 99%

Urgent distal pancreatectomy for intraperitoneal hemorrhage due to the spontaneous rupture of a pancreatic metastatic tumor from synovial sarcoma: a case report

et al. 2020

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Background: Synovial sarcoma is a soft tissue malignancy that frequently affects the extremities, adjacent to the large joints. Synovial sarcoma has a high rate of distant metastasis; however, pancreatic metastasis is extremely rare, and to our knowledge, there has been no report of bleeding due to spontaneous tumor rupture. This study reports the case of a patient with synovial sarcoma pancreatic metastasis causing tumor rupture and bleeding, which was successfully managed with emergent distal pancreatectomy. Case presentation: A 27-year-old woman underwent extensive resection of the primary tumor and partial lung resection after chemotherapy for left femoral synovial sarcoma and multiple lung metastases 4 years prior. During the follow-up, a 35-mm tumor was noted in the pancreatic tail on abdominal computed tomography (CT), and no other distant metastases were detected via positron emission tomography CT. Laparoscopic distal pancreatectomy was scheduled for pancreatic metastasis of synovial sarcoma. However, before the scheduled pancreatectomy could be conducted, the patient visited the emergency department because of abdominal pain that occurred after consuming a small amount of alcohol, and CT showed ascites with high CT values and leakage of contrast media. She was diagnosed with intra-abdominal hemorrhage due to a ruptured metastatic pancreatic tumor, and an emergency operation was performed. In total, 1500 mL of blood was evacuated from the abdomen, and the bleeding pancreatic tail tumor was resected. Histopathological findings revealed synovial sarcoma metastasis and a ruptured tumor capsule, and tumor cells were observed in the hematoma. After discharge on postoperative day 18, the patient was carefully monitored and confirmed to be in relapse-free survival, without chemotherapy, at 6 months post-surgery.

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