Pancreatic Adenocarcinoma With Synchronous Colonic Metastases

Introduction and importance Pancreatic adenocarcinoma is one of the leading causes of death. Presentation with colonic metastases is far less frequently reported in the literature and may be misdiagnosed as colonic adenocarcinoma. We report the case of a female patient with metastatic pancreatic adenocarcinoma that presented with a sigmoid obstruction. Case presentation A 66-year-old female presented with constipation and abdominal pain. She was found to have an obstructing sigmoid colon lesion, multiple metastatic lesions in the liver, and a pancreatic tail lesion. She underwent left hemicolectomy and ostomy placement. The gross pathology of the colon and needle biopsy of the liver was consistent of pancreatobiliary origin. Genomic screening performed, patient found to be KRAS G12R mutated. She was given one cycle of chemotherapy, thereafter was referred to hospice care. Clinical discussion Primary metastatic pancreatic cancer is now the 2nd most diagnosed cancer in the United States after lung cancer. The prognosis for the malignancy is poor, patients are usually diagnosed late at the time that the tumor has metastasized to other organs. Colonic metastasis is a rarely seen and far less frequently reported in the literature. Next-generation-sequencing was performed at baseline to further characterize her tumor for any actionable mutations. Conclusion Pancreatic adenocarcinoma is an aggressive malignancy with a poor prognosis. Next-generation-sequencing may offer targeted therapy if an actionable mutation is present such as our patient's, however due to late diagnosis, rapid clinical deterioration, and next-generation sequencing delay we were unable to alter the patient's outcome.

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“…Thereafter the patient initiated palliative abraxane/gemzar chemotherapy. No further follow up indicated [5] .…”

Section: Discussionmentioning

confidence: 98%

Pancreatic cancer presenting as bowel obstruction and role of next generation sequencing: A case report

Ardalan

Azqueta

England

et al. 2022

International Journal of Surgery Case Reports

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“…The patient subsequently received routine treatment for locally advanced rectal cancer in our institution at the time; this treatment would not have been recommended had the diagnosis been known preoperatively and indeed non-operative management with palliative chemotherapy would usually be recommended for stage 4 PDAC. There have been six previous case reports of synchronous colonic metastases from PDAC [ 13–18 ], three reports of metachronous metastases from PDAC [ 12 , 19 , 20 ] and one report of metachronous colonic metastases from pancreatic acinar cell cancer (PACC) [ 21 ]. Pancreatic metastases were either confirmed or suspected preoperatively in three of those with synchronous disease [ 13 , 16 , 17 ] and two of those with metachronous disease [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…There have been six previous case reports of synchronous colonic metastases from PDAC [ 13–18 ], three reports of metachronous metastases from PDAC [ 12 , 19 , 20 ] and one report of metachronous colonic metastases from pancreatic acinar cell cancer (PACC) [ 21 ]. Pancreatic metastases were either confirmed or suspected preoperatively in three of those with synchronous disease [ 13 , 16 , 17 ] and two of those with metachronous disease [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Beware the pancreatic incidentaloma in colorectal tumours: pancreatic adenocarcinoma with metastases to the colon and rectum

O’Sullivan¹,

Burton²,

Dalen³

et al. 2022

Journal of Surgical Case Reports

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Colorectal cancer (CRC) is the third most diagnosed malignancy in the Western world. Routine staging of CRC often identifies incidental lesions on cross-sectional imaging. Appropriate treatment is dependent on a correct histological diagnosis. Pancreatic Ductal Adenocarcinoma (PDAC) is a rarer and often devastating diagnosis for which the treatment pathway differs significantly to CRC. We report two rare cases: the first recorded case of PDAC with synchronous rectal metastasis and a case of an acute presentation with large bowel obstruction from synchronous colonic metastasis. Both cases presented a significant diagnostic challenge. The management of both cases would have been altered had the histological diagnosis been known prior to surgery. Clinicians treating CRC should be wary of incidental lesions on staging investigations as they rarely represent an occult extra-intestinal primary malignancy. Immunohistochemistry plays an important role in ascertaining the origin of gastrointestinal malignancy.

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“…Recently, more attention has been paid to the underlying molecular mechanisms that play an important Journal of Oncology 5 role in the organ-specific metastasis of breast cancer cells [15]. Previous studies have demonstrated that the liver, lung, bone, brain, and distant lymph nodes are the common sites of metastases from pancreatic adenocarcinoma [17][18][19][20]. In 19.9% of patients, LMs were found at initial diagnosis of primary cancer.…”

Section: Discussionmentioning

confidence: 99%

Systematic Pan-Cancer Population-Based Analysis Reveals the Incidence and Prognosis of Lung Metastases at Diagnosis

Liang

Cheng

Zhou

et al. 2021

Journal of Oncology

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Background. Metastasis is one of the most prevalent causes of death in cancer patients and the lungs are among the organs most commonly affected by metastasis. However, analysis of the incidence and prognosis of lung metastasis (LM) based on primary cancer sites is lacking. Methods. We enrolled cancer patients with LM from the Surveillance, Epidemiology, and End Results (SEER) database. The risk factors for LM were determined using multivariate logistics regression. Forest plots were used to compare the impact of with LM versus without LM alone among different primary caner site subgroups. Results. Among 1,525,441 cases, 47,537 presented with LM at initial diagnosis. Multivariate logistics regression revealed that male sex, older age, later T/N stage, unmarried status, and lack of insurance were risk factors for LM. The incidence of LM was 11.91% in bone cancer and 11.19% in pancreatic cancer. In terms of the distribution of primary cancers, 19.22% of LMs originated from the colon and rectum, with 11.63% from the kidneys. The median survival for LM cases was 6 months, with the best survival in testicular cancer (19 months) and bone cancer (12 months). Patients with LM had higher hazard ratio (HR) for mortality compared to those without LM, except for those with primary cancer in the brain ( P = 0.09 ). We stratified patients by primary cancer site, and subgroup analyses showed that LM had a significant negative impact on survival. The most significant was in thyroid cancer (HR = 44.79), followed by melanoma (HR = 24.26), prostate (HR = 16.0), breast (HR = 13.46), endometrial (HR = 12.64), testicular (HR = 12.31), and kidney (HR = 11.33) cancer (all P < 0.001 ). Conclusion. Patients presenting with LM had higher HR for mortality compared to those without LM, except for those with brain tumor. Clinicians should pay more attention to the occurrence of LM, especially in patients with a significantly increased HR for mortality, such as those with thyroid cancer, melanoma, and prostate cancer.

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Pancreatic Adenocarcinoma With Synchronous Colonic Metastases

Cited by 9 publications

References 10 publications

Pancreatic cancer presenting as bowel obstruction and role of next generation sequencing: A case report

Pancreatic cancer presenting as bowel obstruction and role of next generation sequencing: A case report

Beware the pancreatic incidentaloma in colorectal tumours: pancreatic adenocarcinoma with metastases to the colon and rectum

Systematic Pan-Cancer Population-Based Analysis Reveals the Incidence and Prognosis of Lung Metastases at Diagnosis

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