Pancreatic Metastasis of a Colic Carcinoma

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Pancreatic Metastasis of a Colic Carcinoma

Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 19, Issue 1

Abstract

Pancreatic secondary tumours are rare and motivate 1.6 and 3.9% of pancreatic resections [1,2]. Most published cases are metastases of clear cell renal carcinoma, but other tumours can also metastasize to the pancreas. This is the case of colorectal adenocarcinomas which cause 6.2% of pancreatic metastases. Few cases have been published. However, this possibility should not be overlooked when interpreting CT and using body-whole scanning methods such as PET scans as illustrated by the observation below.This 63-year-old patient had a history of rectal adenocarcinoma treated by previous resection in April 2003. It was a pT2N0MO lesion. Due to the presence of vascular emboli, adjuvant treatment was performed by external radiotherapy at a dose of 45 grays combined with six courses of chemotherapy with LV5-FU2. It was sent to us in October 2005 following the discovery by ultrasonography then CT of a single hepatic metastasis of segment VI. The serum level of the carcinoma-embryonic antigen (CEA) was 3 times higher than normal. The 18 FDG PET scan revealed no other zone of hyperfixation than the liver lesion. A right hepatectomy was therefore performed on November 10, 2005. Anatomopathological examination of the operative specimen found a metastasis of a moderately differentiated adenocarcinoma 4.5cm long axis with presence of vascular embolisms. The margins of excision were greater than 1cm. The indication for adjuvant chemotherapy was retained in the tumor board with four courses of Folfox chemotherapy. Serum CEA level normalized postoperatively. In December 2006, the abdominal CT performed as part of the post-treatment surveillance showed a hypodense zone of 2.5cm in diameter sitting in the body of the pancreas and associated with dilation of the Wirsung canal. This image was taking contrast in an isolated way in18-FDG PET scan, evoking a malignant tumor. At the same time, the serum level of CEA was increased again. All of these signs were in favor of a primary or secondary pancreatic malignancy. Considering the age of the patient and the absence of comorbidities, a pancreatectomy with caudal splenic preservation was performed in January 2007. The pathological examination of the resection piece found a tumor of 6 centimeters large axis, infiltrating the wall of large veins, with peri-nerve sheaths. The excision was microscopically complete. It was a moderately differentiated mucosecreting adenocarcinoma infiltrating the pancreas and peri-pancreatic fat. The eight peri-tumoral ganglia were not invaded. The immunohistochemical profile (CK7 negative and CK positive) was in favor of intrapancreatic metastasis of rectal adenocarcinoma. The postoperative period was complicated with a thrombosis of the splenic artery. Adjuvant chemotherapy according to the LV5 FU2 protocol was provided (because the patient had oxaliplatin neuropathy). The CT scan and PET scan performed in September 2007 showed metastatic liver recurrence. The chemotherapy that was implemented did not allow oncologic response and the patient died on June 14, 2010 of the evolution of her cancerous pathology.

Authors and Affiliations

Niki Christou, Frederic Ris, Muriel Mathonnet

Keywords

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EP ID EP622386
DOI 10.26717/BJSTR.2019.19.003248
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