Tucker Catherine M, Godcharles Cheryl L, Jiang Wei, Yeo Charles J, Rosenblum Norman G, Halpern Ethan J, Luginbuhl William E, Prestipino Anthony J
Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
J Pancreat Cancer. 2021 Oct 14;7(1):74-79. doi: 10.1089/pancan.2021.0001. eCollection 2021.
In this study, we present the case of a 64-year-old female with a chief complaint of abdominal pain and bloating, which had been persistent over a period of 4 months. Imaging revealed a 6.1-cm left-sided pancreatic mass as well as a 19.1-cm multiloculated cystic lesion in the pelvis, later revealed to be replacing the left ovary. The pancreatic mass was biopsied through endoscopic ultrasound-guided fine needle aspiration, and diagnosed as adenocarcinoma by cytology. The patient was treated with neoadjuvant chemotherapy and radiation before laparotomy for resection of the pancreas and left adnexal mass. Her response to treatment was followed radiologically and biochemically with cancer antigen (CA) 19-9 (114-35 U/mL), carcinoembryonic antigen (12-4.8 ng/mL), and CA-125 (119-15.3 U/mL) levels. She subsequently underwent an Appleby procedure, and resection of left pelvic mass and bilateral oophorectomy. Permanent sections revealed residual pancreatic ductal carcinoma with treatment effect, and a multicystic epithelial neoplasia of the left ovary for which the differential was primary ovarian carcinoma versus metastatic disease. Molecular mutational analysis was performed on sections of both the ovarian tumor and the pancreatic tumor to aid in diagnosis. The ovarian tumor in this case showed exactly the same mutations, and , as in the treated pancreatic cancer. This raised the high probability that these tumors originated from the same clonal event. The findings suggested that the ovarian tumor was an isolated metastasis of the pancreatic primary, despite the morphologic ambiguity between the two sites of neoplasia.
在本研究中，我们报告了一例64岁女性患者，其主要症状为腹痛和腹胀，持续了4个月。影像学检查发现左侧胰腺有一个6.1厘米的肿块，盆腔有一个19.1厘米的多房囊性病变，后来发现该病变取代了左侧卵巢。通过内镜超声引导下细针穿刺对胰腺肿块进行活检，细胞学诊断为腺癌。患者在剖腹手术切除胰腺和左侧附件肿块之前接受了新辅助化疗和放疗。通过癌症抗原（CA）19-9（114 - 35 U/mL）、癌胚抗原（12 - 4.8 ng/mL）和CA-125（119 - 15.3 U/mL）水平对其治疗反应进行影像学和生化随访。她随后接受了Appleby手术，切除左侧盆腔肿块并进行双侧卵巢切除术。永久切片显示有治疗效果的残留胰腺导管癌，以及左侧卵巢的多囊性上皮性肿瘤，鉴别诊断为原发性卵巢癌与转移性疾病。对卵巢肿瘤和胰腺肿瘤的切片进行了分子突变分析以辅助诊断。该病例中的卵巢肿瘤显示出与经治疗的胰腺癌完全相同的突变，即 和 。这增加了这些肿瘤起源于同一克隆事件的高可能性。这些发现表明，尽管两个肿瘤部位在形态学上存在模糊性，但卵巢肿瘤是胰腺原发肿瘤的孤立转移灶。
