Metastatic pancreatic adenocarcinoma presenting as an occipital haemorrhage

Ng, Jessica; How, Elena; Schwindack, Christian; Lam, Alfred King‐Yin

doi:10.1136/bcr-2018-224354

BMJ Case Reports

2018

DOI: 10.1136/bcr-2018-224354

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Metastatic pancreatic adenocarcinoma presenting as an occipital haemorrhage

Jessica Ng¹,

Elena How

Christian Schwindack

et al.

Abstract: We report a case of a 63-year-old woman who was presented to the emergency department with an occipital haemorrhage secondary to a pancreatic cerebral metastasis. Pancreatic cancer is the ninth most common cancer in women in Australia, and distant disease is present in 70% of patients with pancreatic cancer at the time of diagnosis. However, metastases to the brain are rare, accounting for only 0.33%-0.57% cases antemortem. Herein, we discuss the management of this unusual case to highlight the importance of r… Show more

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Clinical and molecular characteristics of patients with brain metastasis secondary to pancreatic ductal adenocarcinoma

Yousef,

Hurd,

Yousef

et al. 2024

The Oncologist

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Background The prognosis for patients with pancreatic ductal adenocarcinoma (PDAC) is poor. Secondary brain metastasis (Br-M) occurs in less than 1% of patients. Clinical characteristics and molecular alterations have not been characterized in this rare patients’ subset. Materials and methods The Foundry software platform was used to retrospectively query electronic health records for patients with Br-M secondary to PDAC from 2005 to 2023; clinical, molecular, and overall survival (OS) data were analyzed. Results Br-M was diagnosed in 44 patients with PDAC. Median follow-up was 78 months; median OS from initial PDAC diagnosis was 47 months. Median duration from PDAC diagnosis to Br-M detection was 24 months; median OS from Br-M diagnosis was 3 months. At Br-M diagnosis, 82% (n = 36) of patients had elevated CA19-9. Lung was the most common preexisting metastatic location (71%) with Br-M, followed by liver (66%). Br-M were most frequently observed in the frontal lobe (34%, n = 15), cerebellar region (23%, n = 10), and leptomeninges (18%, n = 8). KRAS mutations were detected in 94.1% (n = 16) of patients who had molecular data available (n = 17) with KRASG12V being the most frequent subtype 47% (n = 8); KRASG12D in 29% (n = 5); KRASG12R in 18% (n = 3). Patients who underwent Br-M surgical resection (n = 5) had median OS of 8.6 months, while median OS following stereotactic radiosurgery only (n = 11) or whole-brain radiation only (n = 20) was 3.3 and 2.8 months, respectively. Conclusion Br-M is a late PDAC complication, resulting in an extremely poor prognosis especially in leptomeningeal disease. KRAS was mutated in 94.1% of the patients and the KRASG12V subtype was prevalent.

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Clinical and molecular characteristics of patients with brain metastasis secondary to pancreatic ductal adenocarcinoma

Yousef,

Hurd,

Yousef

et al. 2024

The Oncologist

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Pancreatic adenocarcinoma with brain metastases

Law

Lomma

2023

BMJ Case Rep

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Brain metastases are rare for patients with pancreatic adenocarcinoma. The incidence of brain metastasis may increase as improved systemic treatment regimens improve overall survival. Given the low incidence of brain metastasis, recognition of disease and management remain a challenge. We report three cases of metastatic pancreatic adenocarcinoma with brain metastases, review the literature and discuss its management principles.

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Late metachronous cerebral metastasis of pancreatic adenocarcinoma of the tail of the pancreas: a case report

et al. 2022

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Background Pancreatic cancer is one of the leading causes of cancer mortality and one of the most lethal malignant neoplasms worldwide. It is known for its local tumor extension to the liver; other common sites include the lung, distant lymph nodes, and bone. Brain metastases are extremely rare and represent less than 0.6% of all brain metastases. Case report We report the case of a 66-year-old Caucasian female known to have adenocarcinoma of the tail of the pancreas treated with chemotherapy. During follow-up, thoracoabdominal computed tomography scans did not reveal any residual tumor or any metastasis. Moreover, tumor markers were within normal limits. She presented to the emergency department of our institution following an episode of a generalized tonic–clonic seizure 5 years following the initial diagnosis. Brain magnetic resonance imaging revealed an expansive left frontal intraaxial lesion compatible with high-grade glioma. The patient underwent surgical treatment. Histological examination revealed pancreatic metastasis. Conclusions Thought to be rare, metachronous cerebral pancreatic metastasis should be kept in mind in patients with pancreatic cancer. Early diagnosis and complete surgical resection play a key role in the survival of these patients.

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Metastatic pancreatic adenocarcinoma presenting as an occipital haemorrhage

Cited by 3 publications

References 3 publications

Clinical and molecular characteristics of patients with brain metastasis secondary to pancreatic ductal adenocarcinoma

Clinical and molecular characteristics of patients with brain metastasis secondary to pancreatic ductal adenocarcinoma

Pancreatic adenocarcinoma with brain metastases

Late metachronous cerebral metastasis of pancreatic adenocarcinoma of the tail of the pancreas: a case report

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