Mano Yohei, Sugimachi Keishi, Shimagaki Tomonari, Tomino Takahiro, Onishi Emi, Lee Lingaku, Hisano Terumasa, Koga Yutaka, Taguchi Kenichi, Morita Masaru, Toh Yasushi
Department of Hepato-Biliary and Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan.
Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita, 870-0033, Japan.
Surg Case Rep. 2023 Sep 29;9(1):173. doi: 10.1186/s40792-023-01755-z.
Liver metastasis of pure squamous cell carcinoma (SCC) from pancreatic ductal adenocarcinoma has not been previously reported.
A 66-year-old man underwent a computed tomography scan 3 years after surgery for pancreatic head cancer, and the scan revealed a mass lesion in the right lobe of the liver. A liver tumor biopsy was performed, and SCC was diagnosed. Whole sections of the pancreatic head cancer were re-evaluated, but no areas of SCC-like differentiation were identified. Although the pathology differed between the pancreas and liver, metastasis of adenosquamous carcinoma was considered. Three courses of gemcitabine plus nab-paclitaxel were administered to treat the liver metastasis of pancreatic cancer, but no response was attained. Therefore, primary SCC of the liver was considered and hepatic resection was performed. The tumor had invaded the diaphragm, and S5/6 partial hepatic resection with right diaphragm resection was performed. Pathological examination showed pure SCC of the liver, which differed from the pancreatic cancer. KRAS mutations were evaluated in the pancreatic and liver tumor specimens, and Q61R mutation was identified in both specimens. This pure SCC of the liver was diagnosed as metastasis from pancreatic cancer not by histology but by genetic analysis.
This is the first reported case of pure SCC liver metastasis from pancreatic cancer without a squamous cell component in the primary tumor. Evaluation of KRAS mutations in both specimens was useful for diagnosis.
胰腺导管腺癌纯鳞状细胞癌（SCC）肝转移此前未见报道。
一名66岁男性在胰头癌手术后3年接受计算机断层扫描，扫描显示肝脏右叶有一个肿块病变。进行了肝肿瘤活检，诊断为SCC。对胰头癌的全切片进行了重新评估，但未发现SCC样分化区域。尽管胰腺和肝脏的病理不同，但考虑为腺鳞癌转移。给予三疗程吉西他滨加纳米紫杉醇治疗胰腺癌肝转移，但未取得反应。因此，考虑为原发性肝癌并进行了肝切除。肿瘤侵犯了膈肌，遂行S5/6部分肝切除并切除右膈肌。病理检查显示为肝脏纯SCC，与胰腺癌不同。对胰腺和肝脏肿瘤标本进行了KRAS突变评估，两个标本均鉴定出Q61R突变。这种肝脏纯SCC不是通过组织学而是通过基因分析诊断为胰腺癌转移。
这是首例原发性肿瘤无鳞状细胞成分的胰腺癌纯SCC肝转移报道病例。对两个标本进行KRAS突变评估有助于诊断。
