• morbidity
• pancreatectomy
• pancreatic metastases
• renal cell carcinoma
• survival

• Humans
• Carcinoma, Renal Cell/surgery
• Carcinoma, Renal Cell/mortality
• Carcinoma, Renal Cell/secondary
• Pancreatectomy/methods
• Pancreatectomy/statistics & numerical data
• Male
• Female
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/pathology
• Middle Aged
• Retrospective Studies
• Aged
• Kidney Neoplasms/surgery
• Kidney Neoplasms/pathology
• Kidney Neoplasms/mortality
• Treatment Outcome
• Nephrectomy/methods
• Nephrectomy/statistics & numerical data
• Adult
• Survival Analysis

Pancreatic metastases from squamous cell lung carcinoma (SCLC) are unusual. These lesions are often asymptomatic and detected incidentally or during follow-up investigations, occasionally several years after removal of the primary tumor.

A 56-year-old male with SCLC developed jaundice 1 mo after the cancer diagnosis. An abdominal computed tomography (CT) scan showed a mass in the pancreatic head with distention of both intra- and extrahepatic biliary ducts. Endoscopic retrograde cholangiopancreatography and sphincterotomy were performed first, culminating with plastic biliary stent placement. Cytological examination of the pancreatic mass sample collected by fine-needle aspiration (FNA) under endoscopic ultrasound (EUS) guidance revealed the presence of malignant cells compatible with well-differentiated squamous cell carcinoma. After liver function normalized, chemotherapy was initiated with carboplatin and paclitaxel; however, 4 d later, the patient presented dysphagia. Cervico-thoraco-abdominal CT showed tracheoesophageal fistula and stent migration. After replacement with a 10 cm/10 mm uncovered metallic biliary stent and treatment of the tracheoesophageal fistula with a fully covered esophageal stent, the patient was able to start oral feeding progressively. He died 9 mo after the initial diagnosis.

The diagnosis of pancreatic metastasis from SCLC is challenging for clinicians. EUS-FNA is the primary exam for confirmatory diagnosis.

• Squamous cell lung carcinoma
• Pancreatic metastasis
• Jaundice
• Esotracheal fistula
• Ultrasound endoscopy
• Case report

Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.

• Bile duct obstruction
• Obstructive jaundice
• Pancreas
• Metastasis
• Endoscopic retrograde cholangiopancreatography

• Aged
• Ampulla of Vater/pathology
• Bile Ducts
• Biliary Tract Neoplasms/pathology
• Cholangiopancreatography, Endoscopic Retrograde/adverse effects
• Cholestasis/surgery
• Gallbladder
• Humans

•

Secondary pancreatic tumors are rare, of which a breast primary is extremely uncommon.

Secondary pancreatic tumors are rare, of which a breast cancer primary is extremely uncommon. To our knowledge, we present the 14th case reported worldwide and first from Singapore of lobular breast cancer metastasizing to the pancreas.

A 53-year-old woman presented with painless obstructive jaundice, weight loss over 1.5 months and a 2 cm right breast mass. She had left breast Invasive Lobular Carcinoma (ILC) treated 5 years prior with wide local excision, adjuvant radiotherapy and hormonal therapy. She had elevated bilirubin, liver enzymes and Cancer Antigen (CA) 19–9. Imaging found 3 right breast nodules, left axillary lymphadenopathy, biliary dilatation with an ampullary mass, and bone metastases. Breast nodule biopsies confirmed ILC but ampullary mass cytopathology was inconclusive. Frozen section of the mass during exploratory laparotomy showed metastatic ILC; a triple bypass surgery was done and chemo-endocrine therapy commenced.

ILC is the commonest type of breast carcinoma in cases with pancreatic metastases, usually recurring after long disease-free intervals, and widely metastatic at presentation. Imaging characteristics help differentiate secondary from primary pancreatic tumors. Radiological features and history of an extra-pancreatic cancer suffice in suspecting pancreatic metastases. Despite limited surgical experience, it is well accepted that pancreatic metastasectomy offers reasonably good long-term survival rates, quality of life and can even be curative in highly selected cases.

This case is an interesting case because it highlights the diagnostic dilemma involved in the rare entity of breast cancer metastatic to the pancreas, and summarizes its diagnosis and management.

• Breast cancer
• Breast carcinoma
• Case report
• Metastatic breast cancer
• Pancreatic metastases
• Secondary pancreatic cancer

Secondary pancreatic metastasis from other solid organ malignancy is rare and accounts for less than 2% of all pancreatic tumors. The aim of this study is to highlight that colorectal metastatic disease in the pancreas could be in selected cases an indication for surgery rather than for palliative chemotherapy.

We present a case of a 62-year-old Caucasian female with a history of rectal adenocarcinoma. Four years ago, the patient underwent low anterior resection of the rectosigmoid, post neoadjuvant chemoradiotherapy, with adjuvant chemotherapy. During her follow-up, imaging examinations revealed a lesion in the pancreatic neck with features indicating primary pancreatic cancer. Near-total distal pancreatectomy with en bloc splenectomy was performed. Histopathology revealed metastatic disease compatible with colorectal adenocarcinoma as the primary cancer. Second-line chemotherapy was decided from the institutional tumor board. The patient remains disease free one year later.

Pancreatic lesions in patients with a history of extrapancreatic malignancy should raise suspicions of metastatic disease. Surgical intervention is a legitimate treatment option for these pancreatic lesions, since they represent solitary disease deposits and of course in the context of multidisciplinary meeting decisions, and after proper and extensive staging investigations.

• breast neoplasms
• pancreas
• neoplasm metastasis
• pancreatic neoplasms
• carcinoma, ductal, breast

• Adenocarcinoma/secondary
• Adrenalectomy
• Breast Neoplasms/pathology
• Carcinoma/pathology
• Female
• Humans
• Middle Aged
• Pancreatectomy
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/secondary
• Pancreatic Neoplasms/surgery
• Positron Emission Tomography Computed Tomography
• Splenectomy

• Image-guided intervention
• Interstitial brachytherapy
• Metastases
• Pancreatic cancer
• Radiation therapy/oncology

Metastatic lesion of the pancreas originated from other organs is uncommon. The aim of this report was to evaluate the outcome of surgery in patients with isolated metastases to the pancreas. Nine patients underwent pancreatic resection for metastatic malignant disease from 2000 to 2015 at the Department of Gastroenterological Surgery of the Kumamoto University Hospital. The primary lesion was renal cell carcinoma in 7 cases, colon cancer in 1 and malignant melanoma in 1. The median interval from the initial operation to pancreatic resection was 138 months. Operative procedure was distal pancreatectomy in 6 cases, pancreaticoduodenectomy in 2 and total pancreatectomy in 1. Two patients with renal cell carcinoma and 1 patient with malignant melanoma died 131, 108, and 4 months after the pancreatic resection, respectively. Other 6 patients have survived until now with 23.5 months of observation periods after pancreatic resection. In conclusion, pancreatic metastasis can develop years after the treatment of primary lesion. Pancreatic resection can achieved long-term survival, at least in the patients who had primary renal carcinoma.

• Metastasis
• Operation
• Pancreas

• carcinoma
• endoscopic ultrasound (EUS)
• mesenchymal chondrosarcoma
• pancreaticobiliary
• rapid onsite evaluation

Pancreatic metastases (PMs) are rare and lack of guidelines for diagnosis and treatments .The aim of this study is to explore the diagnosis, treatment, and prognosis of pancreatic metastases.

Twenty-two patients with pancreatic metastases who had been hospitalized at the First Affiliated Hospital of China Medical University from October 1980 to October 2012 were included in the present retrospective study. Seven patients had gastric cancer, five had colon cancer, two each had lung and liver cancer, and one each had bladder cancer, gallbladder cancer, breast cancer, nasopharyngeal cancer, renal cell carcinoma, and carcinoid.

No specific syndrome or imageological change was found for the pancreatic metastases. The most common symptoms were abdominal pain and jaundice. Hypo-echoic lesions with well-defined margins were found on ultrasonic examinations, and low-density lesions with heterogeneous enhancement were identified in CT images. Nineteen of the 22 received treatment. Three of the 8 patients (34.1%) that had undergone operation experienced complications, but all patients recovered after conventional treatment. Follow-up studies were performed for 17 patients (77.3%), and the median survival time from the diagnosis of pancreatic metastases was 13.2 months (range, 2 to 68 months). Of the five patients who underwent radical resection, one was lost to follow-up, one died at fifteen months postoperation, and the other three are still alive and free from disease (disease-free survival ranging from five to thirty-three months from the diagnosis of the pancreatic metastases).

Pancreatic metastases are rare lesions with no specific symptoms. Radical resection should be performed if possible; however, aggressive treatment should be performed for unresectable pancreatic metastases.

Metastases from breast cancer cause the frequent involvement of lung, bone, liver, and brain, while the occurrence of metastases to the gastrointestinal tract is rare, and more frequently discovered after a primary diagnosis of breast cancer. Solitary pancreatic metastases from breast cancer, without widespread disease, are actually unusual, and only 19 cases have been previously described; truly exceptional is a solitary pancreatic metastasis becoming evident together with the primary breast cancer.

A 68-year-old woman reported general fatigue, lethargy, and jaundice. Abdominal ultrasound (US) and magnetic resonance imaging (MRI) showed an ampulloma of Vater’s papilla; moreover, a neoplastic nodule in the left breast was diagnosed. She underwent surgery for both breast cancer and ampulloma of Vater’s papilla. Pathological examination of pancreatic specimen, however, did not confirm primary carcinoma of the duodenal papilla, but showed a metastatic involvement of pancreas from lobular breast cancer. Immunohistochemistry has been essential to confirm the origin of the malignancy: hormone receptors and mammaglobin were expressed in both the primary breast tumor and the pancreatic metastasis.

This is one of the few reported cases in literature of an isolated and synchronous pancreatic metastasis from breast cancer, where the definitive diagnosis was obtained only after surgery. We discuss the controversies in this diagnosis and the choice of correct treatment. The surgical resection of solitary metastases can be performed in the absence of disseminated disease.

• Diagnosis
• Extrapancreatic malignancies
• Metastasis
• Pancreatic cancer
• Therapy

Pancreatic metastases, although uncommon, have been observed with increasing frequency recently, especially by high-volume pancreatic surgery centers. They are often asymptomatic and detected incidentally or during follow-up investigations even several years after the removal of the primary tumor. Renal cell cancer represents the most common primary tumor by far, followed by colorectal cancer, melanoma, sarcoma and lung cancer. Pancreatic metastasectomy is indicated for an isolated and resectable metastasis in a patient fit to tolerate pancreatectomy. Both standard and atypical pancreatic resection can be performed: a resection strategy providing adequate resection margins and maximal tissue preservation of the pancreas should be pursued. The effectiveness of resection for pancreatic metastases is mainly dependent on the tumor biology of the primary cancer; renal cell cancer is associated with the best outcome with a 5-year survival rate greater than 70%.

• Pancreas
• Pancreatic cancer
• Secondary tumor
• Pancreatic resection
• Renal cell cancer