Pancreatic resection for metastatic tumors to the pancreas

Sperti, Cosimo; Pasquali, Claudio; Liessi, G; Pinciroli, Luca; Decet, Giandomenico; Pedrazzoli, Sergio

doi:10.1002/jso.10262

Cited by 139 publications

(145 citation statements)

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“…However, a few cases of leiomyosarcoma with metastases to the pancreas have been reported. Primary sites of leiomyosarcomas included the uterus [6,7] , ovary [8] , veins [9] , spermatic cord [10] , intestine [3,10] , retroperitoneum [2,11] , and soft tissue [11,12] . To the best of our knowledge, including the present case, only 16 cases of pancreatic metastasis from leiomyosarcoma have been reported to date in the English language literature [7,8,12] .…”

Section: Discussionmentioning

confidence: 99%

“…In our case, non-specific abdominal pain appeared to be the most common symptom. The symptoms of pancreatic metastases often include pain, weight loss, obstructive jaundice, and duodenal obstruction, which are very similar to the symptoms of primary pancreatic cancer [1,3,9] . Therefore, pre-operative diagnosis is challenging, and considerable caution is needed for patients with a previous history of non-pancreatic neoplastic disease.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, 18-FDG-PET has proven to be useful for the accurate staging of tumors [3] . Percutaneous fine-needle aspiration (FNA) is found helpful in establishing the correct preoperative diagnosis, especially in patients who are not amenable to surgery, and in assisting in decisions related to the possibility and type of chemotherapy [3] . However, with the exception of postoperative histology, there is no definitive method for unambiguous diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Isolated, potentially resectable pancreatic metastasis is detected infrequently. Therefore, resection of metastatic tumors of the pancreas has been occasionally reported, and its role in improving the survival or quality of life is not clearly defined [3,4] . However, some recent studies have reported that surgical resection can be performed in selected patients with isolated pancreatic metastases, achieving long-ter m sur vival and good palliation [1,5] .…”

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Pancreatic metastasis of leiomyosarcoma in the right thigh: A case report

Koh¹

2007

WJG

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tumors is 1.6%-11% at autopsy [1,2] . The majority of patients with pancreatic metastasis have widespread diseases. Isolated, potentially resectable pancreatic metastasis is detected infrequently. Therefore, resection of metastatic tumors of the pancreas has been occasionally reported, and its role in improving the survival or quality of life is not clearly defined [3,4] . However, some recent studies have reported that surgical resection can be performed in selected patients with isolated pancreatic metastases, achieving long-ter m sur vival and good palliation [1,5] . We report here a case of pancreatic metastatic from leiomyosarcoma of the right anterior thigh, which was treated by surgical resection, and review the literature about pancreatic metastasis. CASE REPORTA 66-year-old woman was referred to our hospital with a mass in the right thigh (Figure 1). In September 2005, she had undergone surgical resection for this mass. Malignant mesenchymoma (70% osteosarcoma and 30% leiomyosarcoma) was diagnosed histologically. In the postoperative period, abdominal computed tomography (CT) identified a pancreatic mass. The patient complained of non-specific abdominal discomfort. Laboratory findings were all within normal limits. The levels of the tumor markers including carcinoembryonic agent and carbohydrate antigen 19-9, were within the normal ranges. Abdominal CT revealed a mass at the head of the pancreas. Magnetic resonance imaging of the abdomen showed a low-intensity mass on T1-weighted images and a non-homogeneous high-intensity mass on T2-weighted images. No evidence of other distant metastases was seen (Figure 1). At laparotomy, a fixed mass of 4 cm or so in length was palpated at the head of the pancreas, displacing the surrounding duodenum. Therefore, pyloruspreserving pancreaticoduodenectomy was performed. Macroscopic examination of the operative specimen showed a 4 cm × 3 cm lobulated solid mass with a thin wall. Microscopic examination revealed a malignant neoplasm with predominance of spindle cells. The tumor cells were immunoreactive for desmin. Metastatic leiomyosarcoma was diagnosed histologically (Figure 2). The postoperative course was uneventful. We recommended systemic chemotherapy to the patient, but she declined. Nine months after the first pancreatic resection, a followup abdominal CT showed development of a new 1-cm mass in the remnant tail of the pancreas (Figure 1). Distal In the postoperative period, a pancreatic mass was identified radiologically by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed. The surgical specimen revealed leiomyosarcoma metastasized to the pancreas. A metastatic nodule on the remnant pancreatic tail was discovered 9 mo after the first pancreatic resection, and distal pancreatectomy was performed. Cases of pancreatic metastasis from leiomyosarcoma are extremely rare, especially when the tumor was resectable. We report here a unique case of pancreatic metastasis from a leiomyosarcoma in the right thigh that had been treated su...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pancreatic metastasis of leiomyosarcoma in the right thigh: A case report

Koh¹

2007

WJG

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“…La supervivencia actuarial a los 2 años es de 54-62%, mientras que a los 5 años se reduce al 25%. La supervivencia media descrita por estos autores es de 22-23 meses (rango de 14-42 meses) (9)(10)(11)(12).…”

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Ictericia secundaria a metástasis pancreática de sarcoma de partes blandas

Álamo¹,

Pareja²,

Gómez³

et al. 2007

Rev. esp. enferm. dig.

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Mujer de 36 años estudiada por ictericia progresiva. Durante la exploración física general se observó una tumoración en la pierna izquierda (Fig. 1), diagnosticándose mediante TAC una masa de 3 cm en la cabeza pancreática con obstrucción de la vía biliar principal (Fig. 2). La biopsia de la tumoración de partes blandas reveló la existencia de células sarcomatosas.La paciente fue sometida a duodenopancreatectomía cefá-lica y exéresis del sarcoma encapsulado de la pierna izquierda. El postoperatorio cursó sin incidencias, siendo alta hospitalaria a los 10 días. El estudio histológico de ambos tumores demostró un sarcoma bien diferenciado, completándose el tratamiento con radioquimioterapia y seguimiento con TAC semestrales. A los 12 meses, no existe evidencia de recurrencia tumoral y la paciente permanence asintomática. DiscusiónBasándonos en el limitado número de casos publicados, el pronóstico del sarcoma primario de páncreas (carcinosarcomas, fibrosarcomas inflamatorios, sarcomas granulocíticos, liposarcomas) parece funesto. Estos pacientes fallecen por la enfermedad primaria, con una esperanza media de supervivencia postoperatoria de 6 meses. De forma extraordinaria algún paciente ha permanecido vivo un año tras la extirpación (1,4).A pesar del mal pronóstico de los sarcomas primarios del pán-creas, las metástasis pancreáticas presentan un mejor pronóstico. La supervivencia a largo plazo tras la extirpación de la enfermedad metastásica en el páncreas es variable. El carcinoma de célu-las renales es el tumor primario descrito con mayor frecuencia en Cartas al Director

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Image of the Month—Diagnosis

2010

Arch Surg

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Pancreatic resection for metastatic tumors to the pancreas

Abstract: Pancreatic resection for metastatic disease to the pancreas should be considered even in selected patients with limited extrapancreatic disease. Long-term survival or good palliation may be achieved.

Cited by 139 publications

References 25 publications

Pancreatic metastasis of leiomyosarcoma in the right thigh: A case report

Pancreatic metastasis of leiomyosarcoma in the right thigh: A case report

Ictericia secundaria a metástasis pancreática de sarcoma de partes blandas

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