Case Report
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World J Gastroenterol. Apr 7, 2014; 20(13): 3693-3697
Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3693
Colonic and anal metastases from pancreato-biliary malignancies
Farshid Ejtehadi, Nikolaos A Chatzizacharias, Rebecca J Brais, Nigel R Hall, Edmund M Godfrey, Emmanuel Huguet, Raaj K Praseedom, Asif Jah
Farshid Ejtehadi, Nikolaos A Chatzizacharias, Emmanuel Huguet, Raaj K Praseedom, Asif Jah, Department of HPB and Transplant Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridgeshire CB2 0QQ, United Kingdom
Rebecca J Brais, Department of Histopathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridgeshire CB2 0QQ, United Kingdom
Nigel R Hall, Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridgeshire, CB2 0QQ, United Kingdom
Edmund M Godfrey, Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridgeshire CB2 0QQ, United Kingdom
Author contributions: All authors contributed in the writing of the manuscript; Brais RJ also conducted the immunohistochemical analysis.
Correspondence to: Dr. Asif Jah, Consultant surgeon, Department of HPB and Transplant Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridgeshire CB2 0QQ, United Kingdom. asif.jah@addenbrookes.nhs.uk
Telephone: +44-1223-257074 Fax: +44-1223-216015
Received: October 28, 2013
Revised: December 27, 2013
Accepted: January 20, 2014
Published online: April 7, 2014
Processing time: 158 Days and 12.6 Hours
Abstract

Pancreato-biliary malignancies often present with locally advanced or metastatic disease. Surgery is the mainstay of treatment although less than 20% of tumours are suitable for resection at presentation. Common sites for metastases are liver, lungs, lymph nodes and peritoneal cavity. Metastatic disease carries poor prognosis, with median survival of less than 3 mo. We report two cases where metastases from pancreato-biliary cancers were identified in the colon and anal canal. In both cases specific immunohistochemical staining was utilised in the diagnosis. In the first case, the presenting complaint was obstructive jaundice due to an ampullary tumour for which a pancreato-duodenectomy was carried out. However, the patient re-presented 4 wk later with an atypical anal fissure which was found to be metastatic deposit from the primary ampullary adenocarcinoma. In the second case, the patient presented with obstructive jaundice due to a biliary stricture. Subsequent imaging revealed sigmoid thickening, which was confirmed to be a metastatic deposit. Distal colonic and anorectal metastases from pancreato-biliary cancers are rare and can masquerade as primary colorectal tumours. The key to the diagnosis is the specific immunohistochemical profile of the intestinal lesion biopsies.

Keywords: Pancreatobiliary cancer; Rare metastatic sites; Colonic metastasis; Anal metastasis; Immunohistochemistry

Core tip: Pancreato-biliary malignancies often present with locally advanced or metastatic disease. Surgery is the mainstay of treatment although less than 20% are suitable for resection at presentation. Common sites for metastases are liver, lungs, lymph nodes and peritoneal cavity and carry poor prognosis, with median survival of less than 3 mo. Distal colonic and anorectal metastases from pancreato-biliary cancers are rare and can masquerade as primary colorectal tumours. The key to the diagnosis is the specific immunohistochemical profile of the intestinal lesion biopsies.