Date Published: January 07, 2020
Publisher: Wolters Kluwer
Author(s): Rohan Yewale, Banumathi Ramakrishna, Kavita Vijaykumar, Partheeban Balasundaram, S. Arulprakash, Patta Radhakrishna, B.S. Ramakrishna.
Metastases from pancreatic malignancy are commonly known to occur in the regional lymph nodes, liver, lung, and peritoneum. Synchronous or metachronous metastasis from the pancreas to the colon is rare, with only 6 cases reported in the literature. We report a man who was found to have adenocarcinoma on biopsies from synchronous lesions in the colon and the pancreas. The immunohistochemistry report revealed the diagnosis of a primary pancreatic malignancy with synchronous colonic metastases.
Pancreatic cancer is the fourth leading cause of cancer deaths worldwide, with an increasing overall incidence as per data from the Surveillance, Epidemiology and End Results Program registries.1,2 A large percentage of affected patients with lesions in the distal body or tail of the pancreas have nonspecific symptoms, and the disease is often detected in its advanced stages when the patient has already developed metastases.3 Metastasis commonly occurs in the regional lymph nodes, liver, lung, and peritoneum. Pancreatic cancer with colonic metastasis is a rare entity, with only 6 cases being reported to date in the literature of which 3 were metachronous lesions.4–9 We present a man who was diagnosed to have adenocarcinoma on colonic biopsies, which was later proved to be a metastatic lesion originating from the pancreas.
A 71-year-old man presented with complaints of intermittent pain in the right lower abdomen for 6 months. The pain was moderate in intensity and nonradiating. It was associated with poor appetite, early satiety, constipation, and unintentional weight loss of 10 kg over the last 6 months. There was a strong family history of malignancy among his siblings, with 2 brothers dying of unspecified malignancy and a younger sister recently operated for breast malignancy. General and abdominal examination were unremarkable except for pallor. Baseline investigations were essentially normal except for low serum hemoglobin (9.7 g/dL), elevated C-reactive protein (78.5 mg/dL), low serum iron (22 μg/dL), and elevated total iron-binding capacity (272 μg/dL).
In comparison with other similar case reports on metachronous colonic lesions, our patient had synchronous colonic lesions. Colonic metastases from other organs typically present with scirrhous morphology, and the tumor tends to infiltrate the colon wall in a manner similar to gastric “linitis plastica.”10 Colonoscopy findings in our case were not typical of primary colonic adenocarcinoma. The atypical appearance of these lesions suggests that the mode of spread could have been externally from peritoneum to serosa and inward or via lymphatics rather than a hematogenous mode of spread.
Author contributions: All authors contributed equally to this manuscript. BS Ramakrishna is the article guarantor.