[Solitary metachronous metastasis of the sternum from pancreatic adenocarcinoma].
Sternal metastases from adenocarcinoma of the pancreas are extremely rare, and even more so when solitary. Two years earlier, the patient reported on here, a 67-year-old man with a solitary osteolytic lesion of the sternal manubrium, had undergone a duodeno-cephalopancreatectomy for adenocarcinoma of the pancreas (G2, pY3, pN1) followed by adjuvant radio-chemotherapy. PET/CT scans, in response to the onset of burning pain in the sternal region, revealed a hypermetabolic area only at the level of the manubrium, while MRI showed a bulging manubrium due to the presence of extensive solid pathological tissue towards the right articulations of the ribs. Abnormal tumour markers were: CEA = 12, n.v. 0-4; Ca 15-3 = 512, n.v. 0-51, Ca 19-9 = 8777, n.v. 0-18. A partial sternectomy was performed with en-bloc resection of the hemiclavicles and the anterior tract of the 1st and 2nd ribs bilaterally with a mediastinic lymphadenectomy and repair with a sandwich prosthesis of prolene mesh and methacrylate, protecting the supra-aortic trunks and the anonymous vein with a polytetrafluoroethylene patch. The histological examination revealed secondary adenocarcinoma with 3 mediastinal metastatic lymph nodes. In view of the severe prognosis, a resection with palliative intent was also performed, which, when carried out in specialised centres, presents no contraindications in terms of cost-benefits.
Lequaglie
Cosimo
C
Centro di Riferimento Oncologico Regione Basilicata, Gestione Sperimentale Integrata CROB, Istituto Nazionale Tumori di Milano, Rionero in Vulture, Potenza.
Della Morte
Aniello
A
Feudale
Elisa
E
Giudice
Gabriella
G
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008197:Lymph Node Excision; D008279:Magnetic Resonance Imaging; D008297:Male; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D016577:Pancreaticoduodenectomy; D049268:Positron-Emission Tomography; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D013249:Sternum / Q000601:surgery; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed