Nogueira Sara Tavares, Pinto Bruno Lima, Silva Eduardo Faria, Garcia Hermano Anjos, Carneiro Francisco
Hospital Professor Doutor Fernando Fonseca, IC19, 2720-276 Amadora, Portugal.
Hospital Professor Doutor Fernando Fonseca, IC19, 2720-276 Amadora, Portugal.
Int J Surg Case Rep. 2018;44:4-7. doi: 10.1016/j.ijscr.2018.01.019. Epub 2018 Feb 9.
Pancreatic cancer is the fourth major cause of cancer-related deaths. About 50% of the patients are diagnosed with advanced disease. Metastatic disease to the colon is a very rare entity with only 5 cases described in english literature.
Male, 60 years-old, presents to a surgical consult with the diagnosis of an adenocarcinoma of the sigmoid colon. The physical exam revealed a periumbilical nodule with suspicious features. The staging CT-scan showed a mass in the tail of the pancreas involving the spleen and left kidney, thickening of the sigmoid colon, multiple mesenteric masses and trabecular changes in the ischium, suggesting metastatic disease. The case was discussed by a multidisciplinary team and it was decided to do a biopsy of the umbilical nodule and review the specimen obtained in colonoscopy. Pathological analysis revealed a metastasis from pancreatic adenocarcinoma. The patient was proposed to start palliative chemotherapy for metastatic pancreatic cancer. After 2 cycles of FOLFOX the patient was admitted in the OR with a perforation of the sigmoid mass. He was submitted to a sigmoidectomy with end colostomy, with discharge at the 5th postoperative day. Pathological analysis of the specimen confirmed the pancreatic origin of the tumor. Patient proceeded with palliative treatment, with death 9 months after the diagnosis.
Pancreatic metastasis to the colon is a very rare entity. Care should be taken when addressing these patients.
Although rare, a sigmoid tumor in a patient with known pancreatic adenocarcinoma must raise the suspicion of metastasis.
胰腺癌是癌症相关死亡的第四大主要原因。约50%的患者被诊断为晚期疾病。胰腺转移至结肠是一种非常罕见的情况，英文文献中仅描述了5例。
一名60岁男性因乙状结肠癌诊断前来接受外科会诊。体格检查发现脐周有一个具有可疑特征的结节。分期CT扫描显示胰腺尾部有一个肿块，累及脾脏和左肾，乙状结肠增厚，多个肠系膜肿块以及坐骨小梁改变，提示存在转移疾病。多学科团队对该病例进行了讨论，决定对脐周结节进行活检并复查结肠镜检查所获取的标本。病理分析显示为胰腺腺癌转移。建议该患者开始针对转移性胰腺癌的姑息化疗。在接受2个周期的FOLFOX方案化疗后，患者因乙状结肠肿块穿孔被收入手术室。他接受了乙状结肠切除术并进行了结肠造口术，术后第5天出院。标本的病理分析证实了肿瘤的胰腺起源。患者继续接受姑息治疗，确诊后9个月死亡。
胰腺转移至结肠是一种非常罕见的情况。处理这些患者时应谨慎。
尽管罕见，但已知患有胰腺腺癌的患者出现乙状结肠肿瘤时必须怀疑有转移。
