Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10265-10272
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10265
Pancreatic cancer with synchronous liver and colon metastases: A case report
Yuan-Mei Dong, Hong-Nian Sun, De-Cong Sun, Mu-Hong Deng, Yong-Gang Peng, Yan-Yun Zhu
Yuan-Mei Dong, De-Cong Sun, Yan-Yun Zhu, Division of Internal Medicine, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing 100071, China
Hong-Nian Sun, Yong-Gang Peng, Department of Medicine, Berry Oncology Corporation, Beijing 102206, China
Mu-Hong Deng, Division of Internal Medicine, Senior Department of Oncology, The First Medical Center of PLA General Hospital, Beijing 100853, China
Author contributions: Zhu YY and Dong YM contributed to patient management and histological evaluation; Sun DC and Deng MH contributed to technical and material support; Dong YM wrote the manuscript; Sun HN and Peng YG reviewed and corrected the manuscript; all authors contributed to revision for important intellectual content and approved the final version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Yun Zhu, MD, Deputy Director, Division of Internal Medicine, Senior Department of Oncology, the Fifth Medical Center of PLA General Hospital, No. 100 Middle West Fourth Ring Road, Fengtai District, Beijing 100071, China. zhuyanyunmm@163.com
Received: April 21, 2021
Peer-review started: April 21, 2021
First decision: June 23, 2021
Revised: June 23, 2021
Accepted: August 17, 2021
Article in press: August 17, 2021
Published online: November 26, 2021
Processing time: 214 Days and 23.5 Hours
Abstract
BACKGROUND

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.

CASE SUMMARY

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 KRAS (p.G12D) and TP53 (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.

CONCLUSION

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.

Keywords: Pancreatic cancer; Colonic metastasis; Immunohistochemical staining; Genomic profiling; Next-generation sequencing; Case report

Core Tip: Metastasis of pancreatic cancer to the colon is rare. Herein, we present a rare case of pancreatic cancer with simultaneous liver and colon metastases. Histopathological examination and immunohistochemical staining of the colon tumor confirmed that the metastasis originated from the pancreas. Next-generation sequencing for genomic profiling of the liver and colon metastases from the primary pancreatic carcinoma were revealed for the first time, with no cancer-predisposing or actionable gene mutations detected. The patient was treated with 12 cycles of FOLFIRINOX, which yielded a sustainable response.