Clinical diagnosis and detection of genetic mutations of pancreatic metastases: A report of four cases and review of the literature

Abstract

Abstract. The present study aimed to report our clinical experience regarding the diagnosis and detection of genetic mutations of pancreatic metastases, and to review the relevant literature to expand knowledge of this disease. A total of 4 cases involving pancreatic metastases, which were treated at The First Affiliated Hospital of Soochow University between January 2013 and July 2016, were retrospectively analyzed. This retrospective study considered the clinicopathological variables of the 4 patients, and compared this data with those from the literature, which was searched using PubMed, EMBASE and the Cochrane Library. All 4 patients with pancreatic metastases were diagnosed by computed tomography (CT) scan and confirmed by pathological staining and immunohistochemistry. Mutation analysis was performed in 3 patients to obtain precise mutation information for guiding and evaluating the use of molecularly targeted drugs. In summary, pancreatic metastases are rare and the majority of pancreatic metastases develop from renal cell carcinoma. Diagnoses of pancreatic metastases predominantly rely on CT, pathology and immunohistochemistry. Detection of mutations has clinical value in auxiliary diagnosis and therapy of pancreatic metastases. Based on mutation information, molecularly targeted drugs may prolong the survival of patients with unresectable pancreatic metastases. IntroductionPancreatic metastases are rare. Metastases are reported to account for 2-5% of all malignant lesions occurring in the pancreas (1-5). Studies have reported that people of ~60 years old are at high risk of developing pancreatic metastases (1-3). Metastases to the pancreas may occur a significant amount of time subsequent to diagnosis and management of the primary tumor (3). Primary tumors that may give rise to pancreatic metastases include renal cell carcinoma (RCC), non-small cell lung carcinoma, melanoma, sarcoma and colorectal carcinoma. Previous studies have indicated that the kidney may be more common than the lung as a primary tumor site of metastases to the pancreas (1,4). Symptoms of pancreatic metastases are often not apparent, and these lesions are thus detected incidentally by physical examination in the majority of cases (6). Abdominal computed tomography (CT) scan and magnetic resonance imaging (MRI) examinations can be used in the differential diagnosis of pancreatic lesions (7). Pathological analysis is the gold standard in the diagnosis of pancreatic metastases (8). However, occasionally it is difficult to diagnose pancreatic metastasis based on pathology alone (9).In recent years, pancreatic metastases have been observed with increasing frequency, particularly at high-volume pancreatic surgery centers, due to increased utilization of advanced imaging methods, including ultrasonography, CT, MRI and endoscopic ultrasonography (EUS) (10). However, the treatment for pancreatic metastases remains controversial. The majority of patients with pancreatic metastases are in the advanced stages of primary disease (11); however, t...

Observations on Solitary Versus Multiple Isolated Pancreatic Metastases of Renal Cell Carcinoma: Another Indication of a Seed and Soil Mechanism?

“…Due to the scarcity of isPM, detailed systematic studies on the genetic/epigenetic profile of isPM have, to our best knowledge, not yet been presented. A MEDLINE (PubMed) based literature research thus revealed only one single presentation [222], reporting on two cases of pancreatic metastasis in RCC in which mutation analysis was performed, in order to evaluate the use of moleculary targeted therapies. There are, however, a few publications comparing non-metastatic with metastatic RCC, however these report on metastatic RCC as one group without taking into consideration different distant metastasis sites or the inclusion of pancreatic metastasis.…”