A resectable pancreatic metastasis from pulmonary adenocarcinoma.
A 67-year-old man, diagnosed as primary pulmonary adenocarcinoma by intraoperative fine-needle aspiration biopsy cytology, underwent right lower lobectomy with radical lymphadenectomy. The pathological stage was Stage IIA (pT1bN1M0, N-reason: 12L positive). After surgery, nodular shadows without intrathoracic lymph node or distant metastasis were demonstrated metachronously three times by follow-up CT. Wedge resection was performed for each of the tumors, and the pathological diagnosis in each case was primary pulmonary adenocarcinoma, Stage IA (T1b), IA (T1a) and IA (T1a), respectively. Five years after the initial pulmonary resection, a follow-up abdominal CT revealed a20-mm nodular shadow. We suspected that this pancreatic tumor might be a primary rather than metastatic one, therefore, pancreatoduodenectomy was performed. Pathological examination revealed adenocarcinoma that was positive for thyroid transcription factor (TTF)-1, allowing a final diagnosis of metastatic pulmonary adenocarcinoma.This case is very rare, because most cases of pancreatic metastasis from lung cancer have already widespread disease at the time of diagnosis.This case illustrates that pancreatic metastasis from pulmonary adenocarcinoma should be borne in mind, even if the pancreatic tumor is a solitary lesion without additional organ metastasis.
Department of General Thoracic Surgery, Maebashi Red Cross Hospital, Gunma, Japan.
Hitoshi
H
Igai
Mitsuhiro
M
Kamiyoshihara
Toshiteru
T
Nagashima
Yoichi
Y
Ohtaki
Kimihiro
K
Shimizu
D000230:Adenocarcinoma / Q000737:chemistry / Q000556:secondary* / Q000601:surgery*; D000077192:Adenocarcinoma of Lung; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008297:Male; D009367:Neoplasm Staging; D009687:Nuclear Proteins / Q000032:analysis; D010190:Pancreatic Neoplasms / Q000737:chemistry / Q000556:secondary* / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011013:Pneumonectomy; D000074482:Thyroid Nuclear Factor 1; D014057:Tomography, X-Ray Computed; D014157:Transcription Factors / Q000032:analysis
D014408:Biomarkers, Tumor; C000614412:NKX2-1 protein, human; D009687:Nuclear Proteins; D000074482:Thyroid Nuclear Factor 1; D014157:Transcription Factors