Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3668-3674
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3668
Metachronous pulmonary and pancreatic metastases arising from sigmoid colon cancer: A case report
Jian Yang, Yu-Chen Tang, Ni Yin, Wei Liu, Zhi-Fei Cao, Xi Li, Xiao Zou, Zi-Xiang Zhang, Jian Zhou
Jian Yang, Yu-Chen Tang, Zi-Xiang Zhang, Jian Zhou, Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Ni Yin, Department of Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Wei Liu, Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Zhi-Fei Cao, Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
Xi Li, Xiao Zou, Department of Medicine, Burning Rock Biotech, Guangzhou 510300, Guangdong Province, China
Author contributions: Yang J and Tang YC reviewed the literature and contributed to manuscript drafting; Yin N and Liu W reviewed the literature, collected and integrated clinical information on the case; Cao ZF analyzed and interpreted the imaging findings; Li X and Zou X analyzed and interpreted next-generation sequencing results, and contributed to manuscript drafting; Zhang ZX and Zhou J were responsible for revision of the manuscript; all authors approved the final version of the manuscript.
Supported by National Natural Science Foundation of China, No. 81902385; Medical Research Projects of Jiangsu Province, No. Y2018094 and No. H2018056; and Science and Technology Project of Jiangsu Province, No. BK20201173.
Informed consent statement: Informed consent form was obtained from the patient for the publication of the case.
Conflict-of-interest statement: The authors declare no potential conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Jian Zhou, MD, PhD, Doctor, Department of General Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, Jiangsu Province, China. zhoujian06@suda.edu.cn
Received: December 4, 2020
Peer-review started: December 4, 2020
First decision: January 25, 2021
Revised: February 6, 2021
Accepted: March 18, 2021
Article in press: March 18, 2021
Published online: May 26, 2021
Processing time: 158 Days and 1.1 Hours
Abstract
BACKGROUND

Metachronous pulmonary and pancreatic metastases from colorectal cancer are rare. The diagnosis of pancreatic metastases is difficult and predominantly relies on computed tomography, pathology and immunohistochemistry. Here, we describe the use of next-generation sequencing (NGS) for determination of the origin of metastasis and prognostic prediction of colorectal cancer.

CASE SUMMARY

A 59-year-old man was diagnosed with sigmoid adenocarcinoma stage IIA (T3N0M0) and underwent surgery in April 2014, followed by XELOX adjuvant chemotherapy. The patient developed pulmonary metastasis in the right upper lung and underwent surgery in May 2016 without further adjuvant chemotherapy. In May 2018, pancreatic metastasis was found and he underwent pancreaticoduodenectomy. After surgery, he was treated with adjuvant S-1 chemotherapy from June 2018 to March 2019. Histopathological review of the specimens from all three lesions indicated consistent patterns characteristic of colon cancer. Concordant gene mutation profiles were observed across the three lesions that included oncogenic driver mutations most frequently seen in colon cancer (e.g., APC, TP53, KRAS and FBXW7). Blood circulating tumor (ct)DNA before adjuvant chemotherapy was undetectable with NGS, suggesting a favorable response to chemotherapy. The patient was alive and well at the latest follow-up visit, achieving a disease-free survival of 17 mo.

CONCLUSION

The genetic profiles of primary tumor, metastases and ctDNA may have clinical value in auxiliary diagnosis, prognosis and therapeutic decision-making.

Keywords: Pancreatic metastasis; Pancreatic metastasectomy; Colon cancer; Circulating tumor DNA; Next-generation sequencing; Case report

Core Tip: We describe a rare case of metachronous pulmonary and pancreatic metastases from colorectal cancer. Immunohistochemistry and next-generation sequencing (NGS) results suggested that pancreatic and pulmonary metastases both originated from the primary colon cancer. To our knowledge, this is the first case to utilize NGS to detect the origin of pancreatic metastasis from colon cancer. NGS also provided useful information for predicting clinical outcome and therapeutic decision-making.