Colonic and anal metastases from pancreato-biliary malignancies.
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.
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.
Farshid
F
Ejtehadi
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.
Nikolaos A
NA
Chatzizacharias
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
RJ
Brais
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.
Nigel R
NR
Hall
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.
Edmund M
EM
Godfrey
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.
Emmanuel
E
Huguet
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.
Raaj K
RK
Praseedom
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.
Asif
A
Jah
D000368:Aged; D001005:Anus Neoplasms / Q000556:secondary*; D001661:Biliary Tract Neoplasms / Q000473:pathology*; D001706:Biopsy; D003110:Colonic Neoplasms / Q000556:secondary*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D041781:Jaundice, Obstructive / Q000150:complications; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Anal metastasis; Colonic metastasis; Immunohistochemistry; Pancreatobiliary cancer; Rare metastatic sites