Oka Yoshito, Takano Shigetsugu, Kouchi Yusuke, Furukawa Katsunori, Takayashiki Tsukasa, Kuboki Satoshi, Suzuki Daisuke, Sakai Nozomu, Kagawa Shingo, Hosokawa Isamu, Mishima Takashi, Konishi Takanori, Kishimoto Takashi, Ohtsuka Masayuki
Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
Department of Molecular Pathology, Chiba University, Chuo-ku, Chiba, 260-8677, Japan.
BMC Gastroenterol. 2021 Jan 6;21(1):9. doi: 10.1186/s12876-020-01587-3.
Pancreatic ductal adenocarcinoma (PDAC) rarely metastasizes to the brain; therefore, the features of brain metastasis of PDAC are still unknown. We encountered simultaneous metastases to the brain and lung in a PDAC patient after curative surgery. Case presentation A 68-year-old man with PDAC in the tail of the pancreas underwent distal pancreato-splenectomy. He received gemcitabine as adjuvant chemotherapy for 6 months. Two months later, brain and lung metastases occurred simultaneously. Considering the systemic condition, the patient received gamma knife treatment and an Ommaya reservoir was inserted for drainage. The patient's condition gradually worsened and he received the best supportive care. To the best of our knowledge, only 28 cases in which brain metastases of PDAC were identified at the time of ante-mortem have been reported to date, including the present case. Notably, the percentage of simultaneous brain and lung metastases was higher (32%) in a series of reviewed cohorts. Thus, lung metastasis might be one of the risk factors for the development of brain metastasis in patients with PDAC. As a systemic disease, it can be inferred that neoplastic cells will develop brain metastasis via hematogenous dissemination beyond the blood-brain barrier, even if local recurrence is controlled. In our case, immunohistochemical staining showed that the neoplastic cells were positive for carbonic anhydrase 9 (CAIX), mucin core protein 1 (MUC1), and MUC5AC in the resected primary PDAC.
We describe a case of simultaneous brain and lung metastases of PDAC after curative pancreatectomy, review previous literature, and discuss the clinical features of brain metastasis of PDAC.
胰腺导管腺癌（PDAC）很少转移至脑；因此，PDAC脑转移的特征仍不清楚。我们遇到一例PDAC患者在根治性手术后同时发生脑和肺转移。病例介绍：一名68岁胰腺尾部PDAC男性患者接受了胰体尾脾切除术。他接受了6个月的吉西他滨辅助化疗。两个月后，同时发生脑和肺转移。考虑到全身状况，患者接受了伽玛刀治疗并插入了Ommaya储液器进行引流。患者病情逐渐恶化，接受了最佳支持治疗。据我们所知，迄今为止，包括本病例在内，仅有28例生前确诊为PDAC脑转移的病例报道。值得注意的是，在一系列回顾性队列研究中，脑和肺同时转移的比例较高（32%）。因此，肺转移可能是PDAC患者发生脑转移的危险因素之一。作为一种全身性疾病，可以推断，即使局部复发得到控制，肿瘤细胞也会通过血行播散越过血脑屏障发生脑转移。在我们的病例中，免疫组化染色显示，在切除的原发性PDAC中，肿瘤细胞碳酸酐酶9（CAIX）、粘蛋白核心蛋白1（MUC1）和MUC5AC呈阳性。
我们描述了一例根治性胰腺切除术后PDAC同时发生脑和肺转移的病例，回顾了既往文献，并讨论了PDAC脑转移的临床特征。
