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30 November 2019 : Case report  Japan

Metachronous Pancreatic Metastasis from Rectal Cancer that Masqueraded as a Primary Pancreatic Cancer: A Rare and Difficult-to-Diagnose Metastatic Tumor in the Pancreas

Mistake in diagnosis, Rare disease

Ryotaro Tani1BCD, Tomohide Hori1ACDEF*, Masahiro Yamada1BCD, Hidekazu Yamamoto1F, Hideki Harada1F, Michihiro Yamamoto1F, Takefumi Yazawa1F, Masaki Tani1F, Yasuyuki Kamada1F, Ryuhei Aoyama1F, Yudai Sasaki1F, Masazumi Zaima1ADF

DOI: 10.12659/AJCR.918669

Am J Case Rep 2019; 20:1781-1787

Abstract

BACKGROUND: Pancreatic metastasis from colorectal cancer is rare and can masquerade as primary pancreatic cancer.

CASE REPORT: A 70-year-old male was diagnosed with advanced rectal cancer with multiple liver metastases. After neoadjuvant chemotherapy, he underwent radical surgery for the primary tumor and hepatectomy for multiple liver metastases. Adjuvant chemotherapies and additional surgeries were subsequently required for recurrences in the liver, lung, and lymph nodes. A diffuse hypovascular nodule in the pancreatic head and a solitary liver metastasis were detected 2.5 years after the initial surgery and he accordingly underwent further chemotherapy. However, the pancreatic tumor progressed, invading the pancreatic duct and biliary tract. Obstructive jaundice finally prompted discontinuation of chemotherapy and he underwent biliary drainage. His diffuse and hypovascular tumor was clinically and radiographically diagnosed as a primary pancreatic cancer. Pancreatic resection for the pancreatic tumor and hepatectomy for the liver metastasis were performed 4.2 years after the initial surgery, achieving radiographic and surgical curative resection. Pathological examination of the surgical specimen resulted in a definitive diagnosis of metachronous pancreatic metastasis from his primary rectal cancer. Despite further chemotherapy, his general condition worsened; however, he remains alive 5.4 years after the initial surgery, with best supportive care.

CONCLUSIONS: Pancreatic metastasis originating from rectal cancer can masquerade as primary pancreatic cancer clinically and radiologically. Multimodality treatment is mandatory for metastatic colorectal cancer. Aggressive surgeries for pancreatic metastasis should be considered if curative resection appears possible radiographically and/or intraoperatively.

Keywords: Colorectal Neoplasms, Pancreas, Rectal Neoplasms, Chemotherapy, Adjuvant, Combined Modality Therapy, Diagnosis, Differential, Hepatectomy, Liver Neoplasms, Pancreatectomy, Pancreatic Neoplasms

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923