title: Surgical resection of a solitary pancreatic metastasis from colorectal cancer: a new step to a cure?
abstract: Isolated metastases to the pancreas from colorectal cancer (CRC) are very rare. We report a case of a 37-year-old man with a hereditary nonpolyposis CRC with a solitary metastasis to the pancreas who was treated with right hemicolectomy, neoadjuvant chemotherapy, complete surgical resection of the pancreatic metastasis, and adjuvant chemotherapy. After 12 months of follow-up, the patient remains free of disease. Differential diagnosis of isolated metastasis to the pancreas should be performed with pancreatic primary adenocarcinomas and neuroendocrine tumors. Symptoms and signs might be similar in these diseases: pain, weight loss, obstructive jaundice, and duodenal obstruction. Nevertheless, both primary and secondary tumors might be totally asymptomatic. Imaging techniques such as computed tomography, ultrasonography, magnetic resonance imaging, positron emission tomography, or endoscopic retrograde colangiopancreatography can provide relevant information about pancreatic lesions. However, it remains difficult to distinguish primary from metastatic pancreatic tumors. Although there is currently very limited experience with the surgical resection of isolated pancreatic metastases from CRC, it should be considered in selected patients with low surgical risk in order to prolong progression-free survival and overall survival. Additional chemotherapy is recommended.
authors.affiliation: Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain. cgravalos@telefonica.net
authors.forename: Cristina
authors.initials: C
authors.lastname: Gravalos
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-Sanchez
authors.forename: Marta
authors.initials: M
authors.lastname: Hernandez
authors.forename: Esther
authors.initials: E
authors.lastname: Holgado
authors.forename: Natalia
authors.initials: N
authors.lastname: Alvarez
authors.forename: Ignacio
authors.initials: I
authors.lastname: García-Escobar
authors.forename: Joaquín
authors.initials: J
authors.lastname: Martínez
authors.forename: Luis
authors.initials: L
authors.lastname: Robles
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000235:genetics / Q000473:pathology*; D003131:Combined Modality Therapy; D018095:Germ-Line Mutation; D006801:Humans; D008297:Male; D051718:MutS Homolog 2 Protein / Q000235:genetics; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D010375:Pedigree
chemical_list: C497172:MSH2 protein, human; D051718:MutS Homolog 2 Protein