Stewart Blake A, Adjei Abdul, Zhang Xiaohong, Oxenberg Jacqueline C
Department of General Surgery, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA.
Department of Hematology/Oncology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA.
Ann Hepatobiliary Pancreat Surg. 2017 Nov;21(4):247-251. doi: 10.14701/ahbps.2017.21.4.247. Epub 2017 Nov 30.
Mucinous tumors of the pancreas are rare and the diagnosis of invasive carcinoma can be a dilemma. While metastatic disease from mucinous cystadenocarcinoma (MCAC) and invasive intraductal papillary mucinous neoplasms (IPMN) have been reported, no extraperitoneal mucinous cystic metastatic disease has been described. When metastatic, the overall survival rates for invasive adenocarcinoma, mucinous cystadenocarcinoma (MCAC) and invasive intraductal papillary mucinous neoplasms (IPMN) are similar. The best improvement in the overall and progression free survival has been demonstrated with FOLFIRINOX (folinic acid - fluorouracil - irinotecan - oxaliplatin) for metastatic adenocarcinoma and Gemcitabine based regimens for MCAC. However, the variable responses of metastatic mucinous lesions have been observed and the overall prognosis remains poor. We describe a case of a patient who presented with metastatic adenocarcinoma of the pancreas as cystic masses in the supraclavicular and axillary regions. Additionally, this patient was initially treated with FOLFIRINOX and continues to have stable primary and metastatic disease after 18 months from the diagnosis.
胰腺黏液性肿瘤较为罕见，侵袭性癌的诊断可能是个难题。虽然已有黏液性囊腺癌（MCAC）和侵袭性导管内乳头状黏液性肿瘤（IPMN）发生转移的报道，但尚未见腹膜外黏液性囊性转移瘤的描述。发生转移时，侵袭性腺癌、黏液性囊腺癌（MCAC）和侵袭性导管内乳头状黏液性肿瘤（IPMN）的总生存率相似。对于转移性腺癌，FOLFIRINOX（亚叶酸 - 氟尿嘧啶 - 伊立替康 - 奥沙利铂）以及对于MCAC基于吉西他滨的方案已被证明能最大程度地提高总生存率和无进展生存率。然而，已观察到转移性黏液性病变的反应各异，总体预后仍然很差。我们描述了一例患者，其表现为胰腺转移性腺癌，在锁骨上和腋窝区域为囊性肿块。此外，该患者最初接受FOLFIRINOX治疗，自诊断后18个月原发性和转移性疾病持续稳定。
