Pancreatic FDG uptake on follow-up PET/CT in patients with cancer

To evaluate the breakdown of unexpected pancreatic ¹⁸F-fluorodeoxyglucose (FDG) uptake and the proportion of secondary primary pancreatic cancer on follow-up, patients with cancer underwent positron emission tomography/computed tomography (PET/CT). The participants consisted of 4,473 consecutive patients with cancer who underwent follow-up PET/CT between January 2015 and March 2019 at Kochi Medical School. Among the participants, 225 with a history of pancreatic cancer were excluded from the present study. Retrospective and blinded PET/CT evaluations of 4,248 patients were performed. In patients with pancreatic FDG uptake, the distribution of FDG uptake in the pancreas was evaluated. The final diagnosis was determined pathologically. A total of 14 (0.3%) of the 4,248 patients exhibited FDG uptake in the pancreatic area. Pancreatic abnormalities were detected in 14 patients, and included five cases of pancreatic metastases (36%), four cases of secondary primary pancreatic cancer (29%), two cases of lymph node metastases (14%), one case of malignant lymphoma (7%), one case of autoimmune pancreatitis (7%) and one case of pseudolesion (7%). One patient with early-stage secondary primary pancreatic cancer had a maximum standardized uptake value (SUV_max) <3.0. The remaining 13 patients had a SUV_max >3.0 in the pancreas. Of the 14 patients, two had multiple foci of FDG uptake in the pancreas. Patients with multiple foci of FDG uptake exhibited pancreatic metastasis from renal cell carcinoma and malignant lymphoma. In conclusion, the majority of patients with unexpected pancreatic FDG uptake on follow-up PET/CT exhibited malignancies; furthermore, ~30% of the malignancies detected in patients with pancreatic FDG uptake were secondary primary pancreatic cancers. In patients with unexpected pancreatic FDG uptake on follow-up PET/CT, primary cancer should be considered as well as metastatic tumors.     

Pancreatic resection for metastatic tumors to the pancreas

BACKGROUND AND OBJECTIVES: The incidence of metastases to the pancreas is very low. The benefit of resection of pancreatic metastasis is poorly defined. In this review we evaluated the outcome of patients undergoing pancreatic resection for metastatic tumors to the pancreas. METHODS: Eight patients underwent pancreatic resection for metastatic tumor from December 1980 to June 2001. The primary cancer was colon carcinoma (n = 4), renal cell cancer (n = 2), duodenal leiomyosarcoma (n = 1), and malignant fibrous histiocytoma (n = 1). The median interval between primary treatment and detection of pancreatic metastases was 36 months. In two cases pancreatic metastases were synchronous with the primary tumor. RESULTS: Four patients underwent pancreatoduodenectomy, two distal pancreatectomy, one total pancreatectomy, and one median pancreatectomy. Associated resection of extrapancreatic lesions was performed in four patients, including two left hepatectomy and two left colectomy. There was no postoperative mortality, but two patients had a pancreatic and a biliary fistula, respectively. Survival averaged 23 months (range 14-42 months): four patients died for metastatic disease from 14 to 42 months after operation, while four patients are alive and well 14 to 31 months after surgery. CONCLUSIONS: Pancreatic resection for metastatic disease to the pancreas should be considered even in selected patients with limited extrapancreatic disease. Long-term survival or good palliation may be achieved.     

A case of metastatic pancreatic cancer which trastuzumab+capecitabine combination therapy was effective

A 61-year-old woman presented with carcinoma of the left breast(T2N1M0, stage II B), which enforced left Bt+R1. In May 2008, the patient underwent preoperative chemotherapy consisting of 4 courses of FEC 75(fluororracil, epirubicin, and cyclophosphamide). Pathological examination revealed that the lesion was a papillotubular carcinoma,(ER-, PgR-, HER2 3+). In September, 2009, CT scans revealed metastases of the cervical lymph nodes and pancreas. Examination of biopsy specimens from the left cervical lymph nodes revealed that the metastases were from breast cancer(ER-, PgR-, HER2 3+). To treat the recurrences, combination therapy with trastuzumab+capecitabine was introduced in October, 2009. CT scans obtained in May 2010 revealed complete response of the metastases of the lymph nodes and pancreas. It is difficult to distinguish a metastases from a primary pancreatic cancer, but the present case was considered to be one of metastic pancreatic cancer because the findings were in agreement with the expression time of lymph node metastasis. Follow-up CT scans revealed that CR was maintained by the combination therapy of trastuzumab+capecitabine.     

钙化肝转移瘤的CT表现

目的报道１３例肝转移瘤钙化的ＣＴ表现。方法１３例钙化肝转移瘤的原发肿瘤１０例为结肠癌,３例为直肠癌。１３例经腹部ＣＴ扫描及Ｂ超检查发现肝转移瘤钙化。１例手术探查活检病理证实为肝转移性腺癌伴坏死及灶状钙化。结果肝转移瘤钙化的ＣＴ表现有３种类型：（１）砂粒样钙化,聚集成团、成片或呈环形;（２）不规则斑片状钙化;（３）斑点状钙化。钙化分布于转移瘤的中心、周边或弥散分布于整个肿瘤中。结论肝转移瘤钙化不多见,其原发肿瘤常为结肠癌。其他如卵巢癌、胃癌、乳腺癌等的肝转移及原发性肝癌也可有钙化,但更为罕见。在不明原发肿瘤的患者作腹部ＣＴ扫描发现肝转移瘤钙化时,应想到原发为结肠癌的可能     

CT staging of pancreatic and periampullary carcinoma.

Sixteen cases of carcinoma head pancreas and seven cases of periampullary carcinoma are staged together on CT scan because of their morphological similarity and similar parameters. Following parameters are considered for CT staging: tumour mass, involvement of splanchnic vessels, locoregional lymph nodes and presence or absence of hepatic metastases. Findings were confirmed on surgical exploration. A contrast enhanced CT scan was 58.3 percent sensitive and 100 percent specific for the involvement of lymph nodes and 100 percent sensitive and 93.4 percent specific for hepatic metastases. The cases diagnosed as non-resectable on CT staging were found inoperable on exploration. Authors believe that for all practical purposes, pancreatic and periampullary malignancies can be grouped together and a contrast enhanced CT scan can provide reliable information for the staging of the tumor.     

Unique intense uptake demonstrated by (18)F-FDG positron emission tomography/computed tomography in primary pancreatic lymphoma: A case report

Patients with primary pancreatic lymphoma (PPL), which is rare, require a different therapeutic approach and have a better prognosis than those with pancreatic cancer. However, conventional imaging modalities alone are not able to differentiate between pancreatic cancer and other rare tumors such as PPL, although the accurate diagnosis of PPL is crucial. The development of new modalities such as F-18 2'-deoxy-2fluoro-D-glucose (FDG) positron emission tomography combined with computed tomography (PET/CT) contributes to the evaluation of lymphoma staging. However, few reports are currently available regarding PET/CT findings in PPL. In this study, a 56-year old man with PPL was examined using FDG PET/CT imaging, which showed the unique intense uptake of FDG in the pancreas with atypical findings of malignancy in the CT scan and magnetic resonance images.     

Re-resection for local recurrence in the remnant pancreas after pancreaticoduodenectomy for pancreatic cancer- a case report

A 70-year-old female suffered from jaundice was admitted to our hospital for a tumor in the pancreas head. CA19-9 and DUPAN-2 levels were increased in laboratory test. Enhanced abdominal computed tomography (CT) scan revealed a low density area of pancreas head. Cytology of pancreatic juice was performed by ERCP, and malignant cells were detected. Pancreaticoduodenectomy was performed under a diagnosis of pancreatic cancer (T3N1M0, stage III). Despite of adjuvant chemotherapy (gemcitabine) after surgery, CT scan revealed a low density area in the cut end of remnant pancreas at 3 months, which was accompanied with elevation of and CA19-9 and DUPAN-2 levels. We diagnosed as a recurrent pancreatic cancer of remnant pancreas without any other side of recurrence and re-resection was performed. Because of chylous ascites and depression following a second surgery, postoperative adjuvant chemotherapy could not be started. Re-recurrence was detected at 3 months after the second surgery, and she died 6 months after the surgery. Remnant or repeated pancreatectomy for local recurrent pancreatic carcinomas is extremely rare with limited number of cases reported in the literature. We report our experience, and discuss the significance of re-resection for recurrence of remnant pancreas.     

A Case of Pancreatic Intraepithelial Neoplasia That Was Difficult to Diagnose Preoperatively

A 63-year-old female patient presented to a local physician with pain in her back and epigastric region. An abdominal computed tomography (CT) scan revealed a pancreatic tumor, and the patient was referred to our hospital. Multiple imaging studies that included ultrasonography (US), CT, MRI, and endoscopic US revealed a cystic lesion 3–4 cm in size with node-like projections in the body of the pancreas. The distal main pancreatic duct was also found to be dilated. Endoscopic retrograde pancreatography revealed an irregular stenosis of the main pancreatic duct proximal to the cystic lesion, and malignancy was suspected. The patient was preoperatively diagnosed with pancreatic ductal carcinoma concomitant with intraductal papillary mucinous carcinoma, and a distal pancreatectomy was performed. Rapid pathological diagnosis during surgery revealed positive surgical margins for pancreatic intraepithelial neoplasia (PanIN). Further resection was performed twice, her surgical margin was positive and total pancreatectomy was ultimately conducted. Histopathological findings revealed diffuse microinvasive cancerous lesions corresponding to PanIN-2 (moderate dysplasia) to PanIN-3 (carcinoma in situ) throughout the pancreas. PanIN involves microlesions of the ductal epithelium that may precede pancreatic cancer. Ascertaining changes in PanIN using images provided by diagnostic modalities such as CT and US is challenging. Ductal stenosis and distal cystic lesions resulting from atrophy and fibrosis of pancreatic tissue were noted around PanIN. Considering the possibility of PanIN, a precancerous lesion during differential diagnosis will help to improve early detection and prognosis for patients with pancreatic cancer.Key Words: Pancreatic intraepithelial neoplasia, Pancreas cancer, Pancreatic duct stenosis, Pancreatic cyst, Diagnosis     

Two-year survivor in response to gemcitabine-based chemotherapy for advanced pancreatic cancer with multiple lung metastases

A 65-year-old woman was admitted to our hospital for appetite loss and jaundice. Abdominal CT scan and ultrasonography both revealed a tumor in the head of the pancreas. Chest CT scan showed multiple nodules in both lungs. The patient was diagnosed as having advanced pancreatic cancer with multiple lung metastases. The primary tumor showed a partial response to the administration of gemcitabine 1,000 mg/m2 on days 1, 8 and 15 of a 28-day cycle. Concurrent treatment with 5-fluorouracil (200 mg/day) was efficacious against the lung metastases. One year later the pancreatic and lung tumors had enlarged, and cisplatin (20 mg/body) was added to the protocol. For 20 months the patient was treated as an outpatient, maintaining good quality of life. The patient died of progressive disease 25 months after her first hospital admission.     

胰腺癌骨转移

目的探讨胰腺癌骨转移的诊断与治疗。方法回顾性分析1999年至2003年间胰腺癌骨转移病例2例。结果经X线、B超、CT、ECT,淋巴细胞rDNA分析,肿瘤细胞学检查、肿瘤标记物检测等方法确诊。1例女性胰腺低分化腺癌,术后2年胸椎及右骶髂骨转移,接受放疗后半年后死亡;1例男性胰腺癌伴胸腰椎骨转移,在行梗阻性黄疸内引流术后1个月因肺部感染,呼吸衰竭死亡,尚未能接受对骨转移灶的治疗。结论影像学检查是发现骨转移瘤的主要方法。胰腺癌骨转移,预后差,除对原发肿瘤治疗外,应积极治疗骨转移灶以延长此类晚期患者的生存期及提高生活质量。     

Renal cell carcinoma of the spindle cell type with metastasis to the pancreas: a case report

We report a case of renal cell carcinoma in a 49-year-old man with multiple metastases, including some to the pancreas which were initially diagnosed as primary pancreatic carcinoma. The first clinical manifestation was jaundice caused by a large metastatic lymph node. Computed tomography showed tumors in the body and tall of the pancreas as well as in the left kidney. Angiography showed that all of the lesions were hypervascular. The patient was finally diagnosed as having renal cell carcinoma. Cholecystectomy and choledochojejunostomy were performed. Intraoperative biopsy of the lymph nodes along the common hepatic artery showed spindle cell carcinoma which was compatible with renal cell carcinoma. Since renal cell carcinoma with pancreatic metastasis is rare, special attention should be paid to its differentiation from primary pancreatic carcinoma in patients with tumors in both the pancreas and kidneys.      

Solitary metastasis to the choroid plexus of the lateral ventricle

Three cases of cancer metastasis to the choroid plexus of the lateral ventricle are reported. The metastases were from sigmoid colon cancer, renal cell carcinoma and pulmonary cancer, and were located in the trigone in two cases and the right inferior horn in one. Total removal was accomplished in all cases without any complications. In addition, eight reported cases of single brain metastasis to the choroid plexus of the lateral ventricle, including clinical and radiological features, are discussed. Peritumoral edema on computed tomographic (CT) scan or magnetic resonance (MR) imaging was found to be an important feature of metastasis developing at this site.     

Surgical Resection of a Solitary Pancreatic Metastasis from Colorectal Cancer: A New Step to a Cure?

Isolated metastases to the pancreas from colorectal cancer (CRC) are very rare. We report a case of a 37-year-old man with a hereditary nonpolyposis CRC with a solitary metastasis to the pancreas who was treated with right hemicolectomy, neoadjuvant chemotherapy, complete surgical resection of the pancreatic metastasis, and adjuvant chemotherapy. After 12 months of follow-up, the patient remains free of disease. Differential diagnosis of isolated metastasis to the pancreas should be performed with pancreatic primary adenocarcinomas and neuroendocrine tumors. Symptoms and signs might be similar in these diseases: pain, weight loss, obstructive jaundice, and duodenal obstruction. Nevertheless, both primary and secondary tumors might be totally asymptomatic. Imaging techniques such as computed tomography, ultrasonography, magnetic resonance imaging, positron emission tomography, or endoscopic retrograde colangiopancreatography can provide relevant information about pancreatic lesions. However, it remains difficult to distinguish primary from metastatic pancreatic tumors. Although there is currently very limited experience with the surgical resection of isolated pancreatic metastases from CRC, it should be considered in selected patients with low surgical risk in order to prolong progression-free survival and overall survival. Additional chemotherapy is recommended.     

胰腺转移肿瘤25例诊治分析

目的:探讨胰腺转移肿瘤的诊断及治疗方法。方法:对1998年10月～2009年8 月空军总医院收治的25例胰腺转移肿瘤进行回顾性分析。结果:原发肿瘤为肺癌8 例、结肠癌5 例、胃癌4 例、胆囊癌3 例、食管癌2 例、肝癌1 例、胃恶性间质瘤1 例、恶性纤维细胞瘤1 例。胰腺转移肿瘤距原发肿瘤时间间隔平均24个月（0～192 个月）。 14例行B 超引导下细针穿刺活检组织病理学诊断;4 例术中冰冻切片诊断、7 例为临床诊断。行胰十二指肠切除+ 横结肠次全切除2 例,胰腺体尾+ 脾脏切除2 例,胆道内金属支架引流术1 例;放疗+ 化疗10例,局部放疗4 例,全身化疗2 例;4 例未治疗。24例随访,手术组中位生存27个月（10～76个月）,非手术治疗组中位生存11个月（2～20个月）,未治疗组中位生存1.5 个月（0.5～6 个月）。 结论:胰腺转移性肿瘤无特异的临床表现,手术切除可延长患者的生存时间。      

肺癌胰腺转移的临床特点及预后分析

背景与目的 由于缺乏特异的临床症状,70%的肺癌患者确诊时为局部晚期或晚期,多数患者伴有实性器官转移,不同部位转移患者的临床表现及预后不同.随着诊断技术的发展,肺癌伴胰腺转移似有逐渐增多趋势.本研究针对肺癌胰腺转移的临床特点、诊治、预后及生存情况进行统计分析,探讨肺癌胰腺转移的相关预后因素.方法 回顾性分析1996年7月-2017年6月于北京肿瘤医院胸部肿瘤内一科就诊的35例经病理确诊的肺癌并胰腺转移或在治疗过程中出现胰腺转移的患者,其中33例有完整随访资料.结果 35例患者中,小细胞肺癌28例(80%),腺癌3例(8.6%),鳞癌4例(11.4%).初治时即存在胰腺转移者21例(60%),14例治疗过程中出现胰腺转移(40%).在胰腺转移灶中,胰头转移者15例(42.9%),胰腺体尾部转移者20例(57.1%),单发转移23例(65.7%),多发转移12例(34.3%).肺癌胰腺转移患者多无明显临床症状,本组病例中,仅4例患者在病程中出现胰腺炎症状.病理类型是影响肺癌胰腺转移患者生存的独立预后因素.结论 部分晚期肺癌患者可以出现胰腺转移,多见于小细胞肺癌.肺癌患者出现胰腺转移,治疗原则以全身化疗为主的综合治疗.病理类型是影响肺癌胰腺转移患者生存的独立预后因素.     

胰腺转移性肿瘤的诊断和治疗

目的探讨胰腺转移性肿瘤的临床病理特点、诊治和预后。方法回顾性分析18例胰腺转移性肿瘤的临床病理资料,其中原发肿瘤为肺癌8例,胃癌2例,恶性纤维组织细胞瘤1例,甲状腺癌1例,黑色素瘤1例,卵巢癌1例,。肾癌1例,食管癌1例,直肠癌1例,肝癌1例。胰腺转移性肿瘤无特异性临床症状。14例行CT或B超引导下细针穿刺活检,经细胞学检查证实;4例由术后组织病理学证实。在18例胰腺继发肿瘤中,单发14例,多发4例。结果CT平扫表现为胰腺低密度肿物,除。肾癌胰腺转移灶表现为高血供,明显增强外,其余均表现为乏血管肿瘤,增强不明显。18例患者均行放化疗综合治疗,治疗后生存期8～38个月,平均生存期19个月。结论胰腺转移性肿瘤在临床上较为少见,无特异的临床症状和影像学表现。根据不同的原发肿瘤,选择合适的综合治疗模式,对于胰腺继发肿瘤的治疗和预后有重要的意义。     

A case of pancreatic acinar cell carcinoma with a giant liver metastasis successfully treated with combination of gemcitabine and peroral S-1

Pancreatic acinar cell carcinoma is rare, and its incidence is less than 1% of all the malignant pancreatic tumors. Little is reported on effectiveness of chemotherapy. We report a 64-year-old male patient with pancreatic acinar cell carcinoma and a giant metastatic liver tumor, which responded to combination chemotherapy with gemcitabine(GEM)and peroral S-1 administration. The patient had upper abdominal pain and hypervascular tumors in liver(15 cm in diameter)and pancreas tail (3 cm in diameter), which were detected by an enhanced abdominal computed tomography(CT)scan, and was admitted for further examination. Abdominal angiography, FDG-positron emission tomography(PET), and liver tumor biopsy led to a diagnosis of pancreatic acinar cell carcinoma in the pancreas tail with liver metastasis. The patient was then treated with combination chemotherapy, which consisted of intravenous infusion of GEM and peroral administration of S-1, and the metastatic liver tumor was markedly reduced(partial response in RECIST). Although the prognosis of patients with unresectable pancreatic acinar cell cancers is generally unfavorable, it is suggested that the GEM/S- 1 combination chemotherapy is effective for these patients' treatment.     

Pancreatic involvement in small cell lung cancer

Background

Few data are available concerning incidence, clinical picture, and prognosis for pancreatic metastases of small cell lung carcinoma. In this paper we review the related literature available in English language.

Conclusions

Although pancreatic metastases are generally asymptomatic, they can rarely produce clinical symptoms or functional abnormalities. The widespread use of multi-detector computerised tomography (CT) in contemporary medical practice has led to an increased detection of pancreatic metastases in oncology patients. Tissue diagnosis is imperative because radiological techniques alone are incapable of differentiating them from primary pancreatic tumours. Pancreatic metastases occur in the relative end stage of small cell lung cancer. The main complications of these lesions, although rare, are acute pancreatitis and obstructive jaundice. Early chemotherapy can provide a survival benefit even in patients with mild acute pancreatitis or extrahepatic biliary obstruction.     

Metastatic tumors to the pancreas: The role of surgery

Pancreatic metastases from other primary malignancies are a rare entity. By far, the most common primary cancer site resulting in an isolated pancreatic metastasis is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma and sarcoma. Only few data on the surgical outcome of pancreatic resections performed for metastases from other primary tumor have been published, and there are no guidelines to address the surgical treatment for these patients. In this study, we performed a review of the published literature, focusing on the early and long-term results of surgery for the most frequent primary tumors metastasizing to the pancreas. Results for the Literature’s analysis show that in last years an increasing number of surgical resections have been performed in selected patients with limited pancreatic disease. Pancreatic resection for metastatic disease can be performed with acceptable mortality and morbidity rates. The usefulness of pancreatic resection is mainly linked to the biology of the primary tumor metastasizing to the pancreas. The benefit of metastasectomy in terms of patient survival has been observed for metastases from renal cell cancer, while for other primary tumors, such as lung and breast cancers, the role of surgery is mainly palliative.     

肾脏转移瘤与肾原发癌CT表现的对比研究

目的 探讨肾转移瘤的ＣＴ表现特点。方法 对比分析经手术病理证实的１１例肾转移瘤及１００例原发肾癌的ＣＴ资料。转移瘤来自肺癌者６例,食管癌２例,肾上腺皮质癌,睾丸精原细胞瘤和原发灶不明各１例。