Shiva Poola, MD1, Ayah Oglat, MD2, Areeba H. Rizvi, MD2, Prashant Mudireddy, MD2; 1East Carolina University, Greenville, NC; 2Vidant Medical Center/ECU Brody School of Medicine, Greenville, NC
Introduction: According the SEER database the incidence of colon cancer has been slowly decreasing over the last 10 years with 5-year survival rate slowly improving; however, locoregional recurrence and metastasis continues to limit survivability. Metastatic colon cancer tends to localize to the lung, liver and peritoneum, while pancreatic metastasis is rare. This case describes a patient with a history of metastatic sigmoid adenocarcinoma cancer who was found to have a pancreatic metastasis.
Methods: A 67-year-old Caucasian Female with a history of stage III sigmoid adenocarcinoma with lung metastasis presented with a week long history of fatigue, weakness, and epigastric discomfort was found to have obstructive jaundice due to a pancreatic metastasis. The patient was diagnosed with moderately differentiated adenocarcinoma of the sigmoid in 2001 and underwent a LAR with pathology demonstrated adenocarcinoma with 1/12 lymph node positivity that was treated with FOLFOX. She had a prolonged course involving lung metastasis requiring neoadjuvant chemotherapy, lobectomy, multiple cyberknife radiosurgeries, and was transitioned to chemotherapy with Capecitabine. In 2019, a PET scan was concerning for new left lung nodule and pancreatic head mass with new CEA elevation (318.4). CT abdomen did not demonstrate a distinct mass in the pancreas. Panitumumab was added to capecitabine regimen. The patient CEA nadired to 10.7 in late 2019. In 2020 she had slow rise of CEA to 40.9 and imaging only noted a mixed therapy response to previous lung nodules with no concern for pancreas involvement. In May 2020, the patient had an acute elevation of LFTs with ALP 452, AST 176, ALT 175, tBili 7.1 and an increase in CEA to 240.1. CT scan found a dilated CBD and pancreatic duct with a 1.1 cm mass at the pancreatic head (Figure 1). ERCP with EUS revealed a 16 mm mass in head and neck of the pancreas with a distal CBD stricture which was treated with an uncovered metal stent. FNA biopsy revealed an adenocarcinoma consistent with colonic origin and immunohistochemical staining was positive for CK20 and CDX-2 with CK 7 negative (Figure 2). LFT elevation resolved with stent drainage. Discussion: This case highlights a case of metachronous colon cancer metastasized to the pancreas. Pancreatic metastasis can be asymptomatic or can present with nonspecific symptoms. Obstructive jaundice is a rare presentation for pancreatic metastasis and should warrant an evaluation in a patient with a history of colon cancer.
Figure 1. CT Scan of Pancreatic Mass
Figure 2. H&E High power magnification shows cribriform, fused, hyperchromatic, pleomorphic glandular structures with luminal necrosis in a background of malignant cells consistent with tumor necrosis (Top Left). CK20 - Positive in tumor cells (Top Right). CDX2- Positive in tumor cells (Bottom Left). CK7- Negative in tumor cells (Bottom Right)
Disclosures: Shiva Poola indicated no relevant financial relationships. Ayah Oglat indicated no relevant financial relationships. Areeba Rizvi indicated no relevant financial relationships. Prashant Mudireddy indicated no relevant financial relationships.