Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2016; 22(12): 3496-3501
Published online Mar 28, 2016. doi: 10.3748/wjg.v22.i12.3496
Pancreatic metastasis from mycosis fungoides mimicking primary pancreatic tumor
Paola Ceriolo, Valentina Fausti, Elisa Cinotti, Silvia Bonadio, Lizzia Raffaghello, Giovanna Bianchi, Giulio Fraternali Orcioni, Roberto Fiocca, Franco Rongioletti, Vito Pistoia, Giacomo Borgonovo
Paola Ceriolo, Course in Paediatric Science, Fetal-Perinatal and Paediatric Pathology, University of Genoa, 16132 Genoa, Italy
Paola Ceriolo, Pathology Unit, Istituto Giannina Gaslini, 16132 Genoa, Italy
Valentina Fausti, Elisa Cinotti, Franco Rongioletti, Section of Dermatology, IRCCS AOU San Martino-IST, 16132 Genoa, Italy
Silvia Bonadio, Giulio Fraternali Orcioni, Pathology Unit, IRCCS AOU San Martino-IST, 16132 Genoa, Italy
Lizzia Raffaghello, Giovanna Bianchi, Vito Pistoia, Laboratory of Oncology, Istituto Giannina Gaslini, 16147 Genoa, Italy
Roberto Fiocca, Pathology Unit, IRCCS AOU San Martino-IST and University of Genoa, 16132 Genoa, Italy
Giacomo Borgonovo, Surgery Unit, IRCCS AOU San Martino-IST and University of Genoa, 16132 Genoa, Italy
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript.
Supported by Cinque per mille e Ricerca Corrente, Ministero della Salute to Istituto Giannina Gaslini.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at the IRCCS AOU San Martino-IST, Genoa, Italy.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paola Ceriolo, MD, PhD, Course in Paediatric Science, Fetal-Perinatal and Paediatric Pathology, University of Genoa, 16132 Genoa, Italy. paolettac@gmail.com
Telephone: +39-33-95794156 Fax: +39-0103075010
Received: April 14, 2015
Peer-review started: April 16, 2015
First decision: June 19, 2015
Revised: July 16, 2015
Accepted: September 13, 2015
Article in press: September 14, 2015
Published online: March 28, 2016
Processing time: 344 Days and 16.1 Hours
Abstract

Mycosis fungoides (MF) is a cutaneous T-cell lymphoma that can undergo local progression with possible systemic dissemination. We report a case of a patient affected by MF with a pancreatic mass that was a diagnostic challenge between primitive tumor and pancreatic metastasis from MF. Clinical setting findings and imaging studies raised the suspicion of a pancreatic primary neoplasm. A diagnostic clue was provided by the combined histomorphologic/immunohistochemical study of pancreatic and cutaneous biopsies, which revealed a pancreatic localization of MF. Considering the rarity of metastatic localization of MF to the pancreas, we next investigated whether chemokine-chemokine receptor interactions could be involved in the phenomenon to provide new insight into the possible mechanisms underlying metastatic localization of MF to the pancreas. Histological analyses of archival pancreatic tissue demonstrated that glucagon-secreting cells of the pancreatic islets expressed the CCL27 chemokine, which may have attracted in our case metastatic MF cells expressing the complementary receptor CCR10.

Keywords: Differential diagnosis; Pancreatic mass; Extracutaneous localization; Mycosis fungoides; CCL27, CCR10

Core tip: We believe that this clinical case is very interesting both for its rarity (mycosis fungoides metastasized to the pancreas) and the complexity of the differential diagnosis. In addition, the investigations performed provide new insight into the possible mechanisms underlying metastatic localization of mycosis fungoides to the pancreas. Indeed, histological analyses of archival pancreatic tissue demonstrated for the first time that glucagon-secreting cells of the pancreatic islets express the CCL27 chemokine, which may have attracted, in our case, metastatic mycosis fungoides cells expressing the complementary receptor CCR10.