Dong Yuan-Mei, Sun Hong-Nian, Sun De-Cong, Deng Mu-Hong, Peng Yong-Gang, Zhu Yan-Yun
Division of Internal Medicine, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China.
Department of Medicine, Berry Oncology Corporation, Beijing 102206, China.
World J Clin Cases. 2021 Nov 26;9(33):10265-10272. doi: 10.12998/wjcc.v9.i33.10265.
Metastasis of pancreatic cancer to the colon is rare and the features need to be further elucidated. Herein, we report a rare case of pancreatic cancer with simultaneous liver and colon metastases.
A 48-year-old man with intrahepatic space-occupying lesions based on a computed tomography scan was admitted to our hospital for further treatment. Abdominal magnetic resonance imaging revealed a 6.4 cm × 4.2 cm mass in the tail of the pancreas and multiple low-density masses in the liver parenchyma. In addition, a mass of 2.2 cm × 1.6 cm with surface congestive erosions in the sigmoid colon was detected by colonoscopy. Histopathological examination of biopsies from both the liver and colon lesions revealed a moderately to poorly differentiated adenocarcinoma. Immunohistochemical staining of the colon tumor was positive for cytokeratin (CK) 7 and CK, but negative for colorectal adenocarcinoma-related markers CK 20, CDX2, and SATB2, thus indicating that the metastasis originated from the pancreas. Next-generation sequencing for genomic profiling of the liver and colon metastases both found mutations in (p.G12D) and (c.376-1delG), with microsatellite stable and low tumor mutational burden without actionable or cancer-predisposing gene mutations detected. The patient was subsequently treated with 12 cycles of FOLFIRINOX which led to a sustainable response, followed by ongoing maintenance treatment with irinotecan plus fluorouracil.
For this rare case, careful evaluation of histopathological and immunohistochemical staining results are required. The genomic profiling of colon lesions was revealed for the first time, and FOLFIRINOX showed good treatment efficacy in this patient.
胰腺癌转移至结肠较为罕见，其特征有待进一步阐明。在此，我们报告一例罕见的同时发生肝转移和结肠转移的胰腺癌病例。
一名48岁男性因计算机断层扫描显示肝内占位性病变入院接受进一步治疗。腹部磁共振成像显示胰腺尾部有一个6.4 cm×4.2 cm的肿块，肝实质内有多个低密度肿块。此外，结肠镜检查发现乙状结肠有一个2.2 cm×1.6 cm的肿块，表面有充血糜烂。对肝脏和结肠病变活检组织进行组织病理学检查，结果显示为中分化至低分化腺癌。结肠肿瘤的免疫组织化学染色显示细胞角蛋白（CK）7和CK呈阳性，但结直肠癌相关标志物CK20、CDX2和SATB2呈阴性，因此表明转移源自胰腺。对肝脏和结肠转移灶进行基因组分析的二代测序均发现 （p.G12D）和 （c.376 - 1delG）存在突变，微卫星稳定且肿瘤突变负荷低，未检测到可操作的或癌症易感基因突变。该患者随后接受了12个周期的FOLFIRINOX治疗，取得了持续缓解，随后继续接受伊立替康联合氟尿嘧啶的维持治疗。
对于这例罕见病例，需要仔细评估组织病理学和免疫组织化学染色结果。首次揭示了结肠病变的基因组特征，FOLFIRINOX在该患者中显示出良好的治疗效果。
