Soman Arundhati D, Collins Joseph M, DePetris Giovanni, Decker G Anton, Silva Alvin, Moss Adyr, Greer Wendy, Ashman Jonathan, Callister Matthew, Borad Mitesh J
Department of Hematology/Oncology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA.
JOP. 2010 Nov 9;11(6):604-9.
Supraclavicular lymph nodes represent a rare site of metastasis in pancreatic cancer. We report three cases of pancreatic adenocarcinoma with metastases to supraclavicular lymph nodes.
A 51-year-old male was diagnosed with locally advanced pancreatic adenocarcinoma on computed tomography (CT) scan. He was recommended neoadjuvant chemotherapy followed by chemoradiation therapy. However, positron emission tomography (PET)/CT scans and subsequent fine needle aspiration cytology showed supraclavicular lymph node metastasis. The patient received systemic chemotherapy for metastatic pancreatic adenocarcinoma. The second patient, a 66-year-old female with pancreatic adenocarcinoma, underwent pancreaticoduodenectomy and was found to have peripancreatic lymph node involvement. She received adjuvant chemotherapy and was followed-up with surveillance CT scans, which did not reveal any metastasis. However, the patient complained of neck swelling. PET/CT scan and biopsy revealed supraclavicular lymph node metastasis from a pancreatic adenocarcinoma primary. The third patient, a 79-year-old male with a past history of thyroid carcinoma who was treated with partial thyroidectomy, developed neck swelling 4 years after his surgery. Fine needle aspiration cytology was consistent with known papillary thyroid carcinoma. Staging evaluations revealed a pancreatic mass for which he underwent subtotal pancreatectomy and splenectomy. Histopathology revealed grade 3 pancreatic adenocarcinoma. Excisional biopsy of a supraclavicular lymph node showed metastatic pancreatic adenocarcinoma. PET/CT results were consistent with these findings.
In patients with pancreatic adenocarcinoma, supraclavicular lymph node metastasis represents an uncommon, but clinically significant finding that can lead to changes in treatment planning. PET imaging represents a valuable tool in the detection and follow up of these patients.
锁骨上淋巴结是胰腺癌转移的罕见部位。我们报告3例胰腺癌转移至锁骨上淋巴结的病例。
一名51岁男性经计算机断层扫描（CT）诊断为局部晚期胰腺癌。建议他先进行新辅助化疗，然后进行放化疗。然而，正电子发射断层扫描（PET）/CT及随后的细针穿刺细胞学检查显示有锁骨上淋巴结转移。该患者接受了转移性胰腺癌的全身化疗。第二名患者是一名66岁患有胰腺癌的女性，接受了胰十二指肠切除术，发现有胰周淋巴结受累。她接受了辅助化疗，并通过CT扫描进行随访，未发现任何转移。然而，患者抱怨颈部肿胀。PET/CT扫描及活检显示锁骨上淋巴结转移来自原发性胰腺癌。第三名患者是一名79岁男性，既往有甲状腺癌病史，曾接受甲状腺部分切除术，术后4年出现颈部肿胀。细针穿刺细胞学检查结果与已知的乳头状甲状腺癌相符。分期评估发现胰腺有肿块，为此他接受了胰腺次全切除术和脾切除术。组织病理学显示为3级胰腺癌。锁骨上淋巴结切除活检显示为转移性胰腺癌。PET/CT结果与这些发现一致。
在胰腺癌患者中，锁骨上淋巴结转移是一种不常见但具有临床意义的发现，可导致治疗计划的改变。PET成像在这些患者的检测和随访中是一种有价值的工具。
