Metástasis Pancreática Metacrónica de un Carcinoma de Células Renales. Reporte de un Caso / Metachronic Pancreatic Metastasis of a Renal Cell Carcinoma. Case Report

El carcinoma de células renales (CCR) a nivel mundial presenta una incidencia de 431.288 casos anuales, causando 179.368 muertes en 2020. Sin embargo, a pesar de su incidencia, el desarrollo de metástasis pancreática (MP) de un RCC es un hecho inusual. El objetivo de este manuscrito fue reportar el caso de una paciente con una MP metacrónica de un CCR. Se trata de una paciente de 56 años, sexo femenino, nefrectomizada derecha hace 132 meses por un CCR, en adyuvancia con inmunoterapia. En un control imagenológico de rutina, se le pesquisó una lesión de aspecto tumoral en el cuerpo y cola del páncreas. Se intervino quirúrgicamente, realizándose una pancreatectomía córporo-caudal con preservación esplénica. Evolucionó de forma satisfactoria, sin complicaciones, siendo dada de alta al 4º día de su cirugía. El informe del estudio de la pieza operatoria con estudio inmunohistoquímico concluyó que se trataba de una MP de CCR. La paciente se encuentra en buenas condiciones generales y reinició quimioterapia con anticuerpos monoclonales. El seguimiento frecuente y prolongado de pacientes con antecedentes de CCR, facilita un diagnóstico y tratamiento oportuno de MP facilitando el mejor pronóstico de los pacientes, con tasas más altas de supervivencia.

SUMMARY: Renal cell carcinoma (RCC) worldwide has an incidence of 431,288 cases per year, causing 179,368 deaths in 2020. However, despite its incidence, the development of pancreatic metastasis (MP) from RCC is unusual. The aim of this manuscript was to report the case of a patient with a PM of a RCC. This is a 56-year-old female patient, underwent right nephrectomy 132 months earlier for RCC. While she was in adjuvant immunotherapy, in a routine imaging control, it was found a tumor lesion in the body and the tail of the pancreas. So, she underwent surgery, performing a corpora-caudal pancreatectomy with splenic preservation. Postoperative evolution was correct, without complications, and she was discharged on the 4th day after surgery. The report of the study of the surgical piece with an immunohistochemical study included, conclusive of PM of RCC. Currently, the patient is in good general condition and restarted chemotherapy with monoclonal antibodies. Frequent and prolonged follow-up of patients with a history of RCC facilitates timely diag- nosis and treatment of PM, facilitating the best prognosis for patients, with higher survival rates.

Metástasis pancreática como debut de carcinoma papilar de tiroides: caso clínico y revisión del perfil clínico patológico y molecular / Papillary thyroid carcinoma presenting with pancreatic metastases: report of one case

Pancreatic metastases of papillary thyroid carcinoma (PTC) are exceptional. We report a 80-year-old man consulting for obstructive jaundice and dysphonia. Abdominal ultrasonography showed biliary dilation and abdominal magnetic resonance imaging (MRI) showed a pancreatic head mass of 36 mm. A left vocal cord paralysis was confirmed and cervical computed tomography (CT) showed multiple thyroid nodules of up to 35 mm associated with bilateral cervical lymph nodes (LN). Positron emission tomography ( 18 F-FDG PET/CT) evidenced hyper-metabolic activity in bilateral cervical LN, lungs, pancreas and left intercostal soft tissue, as well as left gluteus. Thyroid biopsy reported a tall-cell variant of PTC, and endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic mass confirmed PTC metastasis. The molecular study was positive for BRAFV600E. Pancreatic metastasis from PTC can be accurately diagnosed with 18 F-FDG PET/CT and EUS-FNA, which is consistent with a predominant expression of BRAFV600E mutation and, thus, an aggressive presentation with poor short-term survival.

Pancreatitis aguda en carcinoma de célula pequeña de pulmón (CPCP) resuelta con quimioterapia / Acute pancreatitis in small-cell lung carcinoma (SCLC) resolved with chemotherapy

Resumen El carcinoma de célula pequeña (CPCP) o microcítico de pulmón es un subtipo de cáncer de pulmón que típicamente se ha asociado al tabaquismo y que se caracteriza por su agresividad y mal pronóstico a corto plazo. Como entidad, puede metastatizar en cualquier órgano, siendo las metástasis pancreáticas raras y la mayoría de las veces asintomáticas. Por ello, la presencia de una pancreatitis neoplásica, como en el caso presentado, es excepcional, y aún más cuando presenta refractariedad al tratamiento médico convencional y responde al tratamiento citotóxico sistémico. Por todo ello, se expone esta experiencia clínica y se debate la presencia de esta rara entidad y su manejo.

Abstract Small-cell lung carcinoma is a subtype of neoplasm that has been typically associated with smoking; it is characterized by its aggressiveness and poor prognosis in the short term. As an entity, it can metastasize in any organ, but pancreatic metastases are rare and most of the time asymptomatic. Therefore, the presence of neoplastic pancreatitis as in our case is exceptional; even more when it presents refractoriness to conventional medical treatment, responding instead to systemic cytotoxic treatment. Therefore, we expose our clinical experience and discuss the presence of this rare entity and its management.

Cholestatic syndrome as initial manifestation of pancreatic metastasis of papillary thyroid carcinoma: case report and review

SUMMARY Most papillary thyroid carcinomas (PTC) harbor excellent prognosis. Although rare, distant metastases normally occur in lungs and/or bones. Here we describe a rare case of pancreatic metastasis presenting with rapid onset cholestatic syndrome. A literature review was also performed. A 73-year-old man with a high risk PTC was submitted to total thyroidectomy (TT) followed by radioiodine therapy. After initial therapy, he persisted with progressive rising serum thyroglobulin levels but with no evidence of structural disease. Recently, the patient presented with a rapid onset and progressive cholestatic syndrome. A 4 cm lesion in pancreas was identified, with echoendoscopy fine-needle aspiration biopsy (FNAB) confirming a pancreatic metastasis from PTC. The patient was submitted to a successful pancreaticoduodenectomy. Pancreatic metastases of PTC are rare and few long-term follow-up data are available to guide management. Fourteen cases were former reported, mean age was 65.7 years-old with mean time between PTC and pancreatic metastasis diagnosis of 7.9 years. Nine of them had another distant metastasis, nine were diagnosed by FNAB and just two received sorafenib.

Solitary pancreatic metastasis from breast cancer: case report and review of literature

ABSTRACT CONTEXT: Pancreatic metastases from primary malignant tumors at other sites are rare, constituting about 2% of the neoplasms that affect the pancreas. Pancreatic metastasis from breast cancer is extremely rare and difficult to diagnose, because its clinical and radiological presentation is similar to that of a primary pancreatic tumor. CASE REPORT: A 64-year-old female developed a lesion in the pancreatic tail 24 months after neoadjuvant therapy, surgery and adjuvant radiation therapy for right-side breast cancer (ductal carcinoma). She underwent distal pancreatectomy with splenectomy and left adrenalectomy, and presented an uneventful outcome. The immunohistochemical analysis on the surgical specimen suggested that the lesion originated from the breast. CONCLUSION: In cases of pancreatic lesions detected in patients with a previous history of breast neoplasm, the possibility of pancreatic metastasis should be carefully considered.

Utilidad de la elastografía guiada por ultrasonografía endoscópica en la evaluación de lesiones sólidas pancreáticas / Usefulness of endoscopic ultrasound guided elastography in the assessment of solid pancreatic lesions

Introducción: La elastografía guiada por ultrasonografía endoscópica es considerada una herramienta útil en la evaluación de las lesiones solidas pancreáticas (LSP). Objetivo: El objetivo del estudio fue evaluar el rendimiento diagnóstico de la elastografia en pacientes con LSP. Material y métodos: Se realizó un estudio transversal prospectivo en el hospital Rebagliati durante julio 2017 a junio 2018. Se incluyeron pacientes con diagnóstico de LSP y estudio ecoendoscópico, elastografía y toma de PAAF. Se realizó elastografia cualitativa y elastografia cuantitativa (SR e histograma) y se analizó con resultados histopatológicos para determinar la sensibilidad, especificidad, valor predictivo positivo (VPP), valor predictivo negativo (VPN) y exactitud diagnostica en la detección de malignidad. Resultados: De 846 ecoendoscopías, se estudiaron 46 pacientes con LSP con una edad promedio de 64,6 años, 29 (63%) sexo femenino. El adenocarcinoma pancreático fue diagnosticado en 36 casos (78,3%). En elastografía cualitativa predominó el score 3 (n=39, 84,8%) con una sensibilidad, especificidad y exactitud de 88.9%, 30% y 76,1% respectivamente para predecir adenocarcinoma. Elastografía cuantitativa de SR≥ 15 (sensibilidad 100%, especificidad 66,7% y exactitud 97,8%) y un valor de histograma menor de 49 (sensibilidad 66,7%, especificidad 97,6% y exactitud 95,6%) predice malignidad en una LSP con área bajo de la curva ROC de 0,941 (IC 95%, 0,82 - 1,0). Conclusiones: La elastografía brinda información para predecir la naturaleza maligna de la lesión. En nuestro estudio la detección elastográfica de un score 3, SR≥ 15 o un histograma < 49 predice la presencia de malignidad en la LSP estudiada.

Introduction: endoscopic ultrasonography (EUS) elastography is considered a useful tool for the evaluation of solid pancreatic lesions (SPL). Objective: The aim of our study was to evaluate the diagnostic performance of elastography in patients with SPL. Material and methods: A prospective, cross-sectional study was performed at the Rebagliati Hospital between July 2017 and June 2018. Patients with a diagnosis of SPL and echoendoscopic study, elastography and FNA were included. Qualitative and quantitative elastography: strain ratio (SR) and strain histogram, were performed and analyzed with histopathological results. The diagnostic accuracy of EUS elastography in detecting malignancy was calculated using receiver operating curve analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for the detection of malignancy were calculated. Results: Out of 832 EUS examinations performed, 46 patients with SPL (mean age, 64.6 years; 29 women) were included in the study. Pancreatic adenocarcinoma was diagnosed in 36 cases. In qualitative elastography, score 3 was most frequent (n = 39, 84.8%) with sensitivity, specificity and accuracy of 88.9%, 30% and 76.1%, respectively, for predict adenocarcinoma. A strain ratio of 15 or higher (100% sensitivity, 66.7% specificity and 97.8% accuracy) and a histogram of less than 49 (66.7% sensitivity, 97.6% specificity and 95.6% accuracy) predicts malignancy in SPL, with area under a ROC curve of 0.941 (95% CI, 0.82 - 1.0). Conclusions: EUS elastography provides information to predict the malignant nature of the pancreatic lesion. In our study, the elastographic detection of a score 3, SR≥15 or a histogram <49 predicts the presence of malignancy in LSP.

Clinical and prognostic significance of serum transforming growth factor-beta1 levels in patients with pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) has a poor 5-year survival rate of 5%. Biomarkers for the early detection of pancreatic cancer are urgently needed. Transforming growth factor-beta1 (TGF-β1) is elevated in the tissues and plasma of patients with PDAC. However, no studies systemically report prognostic significance of plasma TGF-β1 levels in PDAC. In the present study, we assessed the prognostic significance of serum TGF-β levels in patients with PDAC. TGF-β levels were determined in serum from 146 PDAC patients, and 58 patients with benign pancreatic conditions. Regression models were used to correlate TGF-β levels to gender, age, stage, class, and metastasis. Survival analyses were performed using multivariate Cox models. Serum levels of TGF-β1 distinguished PDAC from benign pancreatic conditions (P<0.001) and healthy control subjects (P<0.001). Serum levels of TGF-β also distinguished tumor stage (P=0.002) and lymph node metastasis (P=0.001). High serum levels of TGF-β1 were significantly correlated with reduced patient survival. Multivariate analysis revealed that TGF-β1, lymph node metastasis and tumor stage were independent factors for PDAC survival. Our results indicate that serum TGF-β1 may be used as a potential prognostic marker for PDAC.

Higher overall survival in metastatic pancreatic cancer: the impact of where and how treatment is delivered / Maior sobrevida global em pacientes com câncer pancreático metastático: o impacto de onde e como o tratamento é realizado

Objective To determine the overall survival of patients with advanced pancreatic cancer and evaluate factors that impact prognosis in a private cancer center.Methods Data from the Hospital Cancer Registry at Hospital Israelita Albert Einstein were retrospectively collected. The patients enrolled had metastatic cancer at diagnosis or earlier staging and subsequent recurrence. Cases of neuroendocrine tumors were excluded.Results A total of 65 patients were evaluated, including 63 with adenocarcinoma. The median overall survival for patients in all stages was 20.7 months (95%CI: 15.6-25.7), while the overall survival of metastatic disease was 13.3 months. Among the 33 cases with stage IV cancer, there was no evidence of a statistically significant association between median survival and CA19-9 dosage (p=0.212), tumor location (p=0.482), first treatment performed (p=0.337), lymphovascular invasion (p=0.286), and age (p=0.152). However, the number of lines of chemotherapy was significantly associated with survival (log-rank p=0.013), with an estimated median survival of 10.2 months for patients who received up to two lines of treatment and 23.5 months for those receiving more than two lines of chemotherapy.Conclusion The survival of patients treated was longer than that reported in the literature. The only statistically significant factor related to increased survival was higher number of lines of chemotherapy received. We believe that the higher socioeconomic status of patients surveyed in this study, as well as their greater access to treatment options, may have influenced their overall survival.

Objetivo Determinar a sobrevida global dos pacientes com câncer pancreático avançado e avaliar fatores com impacto prognóstico em um centro de câncer privado.Métodos Foram coletados retrospectivamente os dados do Registro de Câncer do Hospital Israelita Albert Einstein. Os pacientes incluídos apresentaram câncer metastático ao diagnóstico ou em estádio mais precoce com recorrência subsequente. Os casos de tumores neuroendócrinos foram excluídos.Resultados Foram avaliados 65 pacientes, incluindo 63 com adenocarcinoma. A sobrevida global mediana dos pacientes em todos os estádios foi 20,7 meses (IC95%: 15,6-25,7), enquanto a sobrevida global de doença metastática foi de 13,3 meses. Entre os 33 casos com câncer em estádio IV, não houve evidência de associação estatisticamente significativa entre a sobrevida mediana e CA19-9 ao diagnóstico (p=0,212), localização do tumor (p=0,482), primeiro tratamento realizado (p=0,337), invasão vasculo-linfática (p=0,286) e idade (p=0,152). No entanto, o número de linhas de quimioterapia foi significativamente associado com a sobrevida (log-rankp=0,013), com uma sobrevida mediana estimada de 10,2 meses para os pacientes que receberam até duas linhas de tratamento e de 23,5 meses para os que receberam mais de duas linhas.Conclusão A sobrevida dos pacientes tratados foi maior do que o relatado na literatura. O único fator estatisticamente significativo relacionado à maior sobrevida foi maior número de linhas de quimioterapia recebidas. Acreditamos que o nível socioeconômico dos pacientes pesquisados neste estudo, assim como seu maior acesso a opções de tratamento, pode ter influenciado em sua sobrevivência global.

Metástasis pancreáticas tardías secundarias a cáncer de células renales: Caso clínico / Pancreatic metastasis from renal cell carcinoma: A case report

We report the case of a 60 year old woman with multiple pancreatic nodules found on abdominal computed tomography. Thirteen years earlier she had undergone a left nephrectomy for renal cell carcinoma. The patient underwent surgery with a preoperative diagnosis of multifocal metastatic or neuroendocrine tumor. At surgery, two metastatic nodules of renal cell carcinoma were found and excised. After four years of follow up there is no evidence of recurrence.

Metástasis pancreática de carcinoma de células renales bilateral asincrónico, 12 años posnefrectomía radical: reporte de caso y revisión de literatura / Pancreatic metastasis of asynchronic bilateral renal cells carcinoma, radical postnephrectomy 12 years: report of one case and literature review

Reportamos un caso de una paciente de 70 años, operada hace 12 años mediante una nefrectomía radical izquierda, de un carcinoma de células renales. Estando en control periódico, consultó por dolor abdominal. El TAC de abdomen mostró una lesión tumoral en la cabeza del páncreas y otra en el riñón derecho. Se realizó una nefrectomía parcial derecha y una pancreatoduodenectomía. La biopsia definitiva fue informada como un CCR claras grado II de Fuhrman, con bordes quirúrgicos negativos para la pieza de tumor renal derecho y como tejido pancreático infiltrado por CCR claras con bordes quirúrgicos negativos, la pieza de pancreatoduodenectomía. Realizamos una revisión a la literatura médica actualmente disponible en relación a este caso.

Pancreatic Metastasis and Obstructive Jaundice in Small Cell Lung Carcinoma

Primary lung cancer frequently metastasizes to distant organs. The pancreas is a relatively infrequent site of metastasis. Furthermore, obstructive jaundice resulting from pancreatic metastasis is extremely rare. This paper examines the case of a 65-year-old woman with small cell lung cancer initially presenting with extrahepatic biliary obstruction. The patient underwent percutaneous transhepatic biliary drainage. The obstruction was relieved with a stent placement, then the woman was treated with combination chemotherapy (irinotecan, cisplatin) and a complete remission achieved in six months.

Solitary pancreatic metastasis from renal cell carcinoma 14 years after nephrectomy: a case report.

We report a case of solitary pancreatic metastasis from renal cell carcinoma which occurred 12 years after radical nephrectomy. The patient had no symptom. The lesion was unrecognized until 2 years later. Distal pancreatectomy was performed and the patient was still doing well 2 years after that operation. We also review the relevant literatures about prognosis, surveillance and choice of treatments for pancreatic metastasis from renal cell carcinoma.

Umbilical mass as the sole presenting symptom of pancreatic cancer: a case report

Nódulos umbilicais são raros. Desde 1846, o comprometimento metastático da região vem sendo descrito. A Irmã Mary Joseph foi a primeira a relacionar o aparecimento de nódulos umbilicais com carcinomas. Esses nódulos podem ser a única manifestação de câncer, normalmente associada a estadios avançados e pior prognóstico. Uma senhora de 64 anos, previamente hígida, apresentava desconforto abdominal inespecífico e aparecimento de nódulo umbilical endurecido há uma semana. O diagnóstico inicial foi hérnia umbilical encarcerada. Após reavaliação, o nódulo foi biopsiado, cujo exame anátomo-patológico demonstrou carcinoma com sítio primário desconhecido. A análise imuno-histoquímica e tomografia, o diagnóstico foi carcinoma de pâncreas. O estadiamento demonstrou doença avançada, com metastáses à distância. A paciente foi submetida a quimioterapia paliativa. Após 8 meses, encontrava-se em mau estado geral. A suspeita clínica deve originar avaliação clínica cuidadosa, auxiliada por exames subsidiários, sempre que um nódulo umbilical apresentar sinais de malignidade.

Pancreaticoduodenectomy for metastatic colonic cancer--report of two cases.

Benefit of resection of metastatic lesions to the liver and lung from colonic cancer is well established. Resection of solitary metastasis or of locally recurrent malignancies in the periampullary region has now become the norm, as it increases survival. We present our experience with two patients with metastases in the periampullary region from previously treated colonic carcinoma who were treated with pancreaticoduodenectomy.

Metástasis pancreática metacrónica de un carcinoma de células renales: tres nuevos casos / Late pancreatic metastasis of a renal cell carcinoma: report of 3 cases

We report two males and one female, aged 71, 81 and 73 years old respectively, previously operated of a renal cell carcinoma. During the follow up of the 71 years old male, the CAT scan showed three lesions in the pancreas. Also, the CAT scan in the female showed one lesion in the tail of the pancreas. The 81 years old male was admitted to the emergency room due to a upper gastrointestinal bleeding. Endoscopy showed a proliferating lesion in the second portion of the duodenum whose biopsy showed a clear cell carcinoma. The CAT scan showed also a tumoral mass in the head of the pancreas. All three patients were subjected to surgical resection of the tumors without postoperative complications or mortality

Metastasis-induced acute pancreatitis in a patient with small cell carcinoma of the lung

Acute pancreatitis in cancer patients can be secondary to the malignant process itself or a complication of antineoplastic agent administration. However, acute pancreatitis caused by metastatic carcinoma of the pancreas is an uncommon condition with a poor prognosis. We report a case of a 63-year-old man with small cell carcinoma of the lung, who developed acute pancreatitis lately. Thirteen months earlier, he developed small cell carcinoma of the lung and received 6 cycles of chemotherapy. Abdominal CT scan showed swelling of the pancreas with multiple masses. The patient was managed conservatively and pancreatitis subsided. This case indicates that metastasis induced acute pancreatitis can be a manifestation of lung cancer, especially in small cell carcinoma.

Ateneo radiológico / Radiology conference

Se trata de una mujer de 78 años que ingresa al hospital con un síndrome de impregnación, intolerancia a los alimentos y vómitos posprandiales precoces. El cuadro clínico hace sospechar un síndrome pilórico causado por una neoplasia abdominal o pelviana. Se solicita una fibroendoscopía digestiva alta (FEDA) que muestra un tumor submucoso en el cuerpo gástrico y una tomografía computada (TC) de abdomen y pelvis con contraste. Luego se decide realizar una Seriada Gastroduodenal (SGD) para determinar si existe una obstrucción distal al estómago

Pancreatic metastasis from renal cell carcinoma

É relatado um caso de carcinoma de células renais que metástases para o pâncreas 7 anos após nefrectomia. Tanto o tumor primário quanto o tumor metástatico tinham o mesmo aspecto histológico. O sintoma dominante no presente caso foi hemorragia digestiva alta, que determinou a morte do paciente

Isolated pancreatic metastasis from locally controlled breast cancer: a case report.

An unusual isolated metastatic carcinoma to the head of pancreas following modified radical mastectomy for operable breast cancer (T2NOMO) done three years earlier is reported. Patient remains free of disease at 27 months following whipple's pancreaticoduodenectomy.