Englewood Hospital and Medical Center Cleveland, OH
Ji Seok Park, MD, Sang Min Chang, MD, Sandarsh Kancherla, MD, FACG; Englewood Hospital and Medical Center, Englewood, NJ
Introduction: Bladder cancer is the most common malignancy in the urinary system. Distant metastasis infers poor prognosis with a 5-year survival rate of only 5%. The metastasis commonly involves liver, lung, and bone, but there have been a few case reports on rare metastasis to intestine, spleen, and pancreas. Our case report emphasizes the early clinical recognition of a clinical syndrome, which should suggest bladder cancer with metastasis to the pancreas rather than primary pancreatic cancer or cholangiocarcinoma.
Methods: A 73-year-old male with a past medical history of smoking, transitional cell bladder cancer, diagnosed 10 years ago, status post cystoprostatectomy with metastatic recurrent in cervical and mediastinal lymph nodes, followed by immunotherapy and chemotherapy with radiologic improvement, presented with abdominal pain. Lipase was 7214 U/L with a normal hepatic function panel. CT did not show any signs of pancreatitis and the patient started tolerating diet and was discharged. However, he was readmitted with abdominal pain and found to have Lipase of 9498 U/L and AST/ALT 226/198 with ALP 220. MRCP showed a 1.4 cm stricture in the CBD and ERCP with biliary stent placement was done (Figure 1). Cytology from biliary brush was negative for malignant cells. He continued to have vague abdominal pain and an MRI was done which showed pancreatic head soft tissue measuring up to 3.5cm with downstream ductal distention to 3mm (Figure 2). EUS showed a mass in the head of the pancreas with peripancreatic lymphadenopathy. FNA biopsy on the pancreas head and peripancreatic lymph nodes showed metastatic poorly differentiated urothelial carcinoma. The patient was referred to his previous oncologist to discuss further care. Discussion: Bile duct stricture with elevated lipase in metastatic bladder cancer is a clinical situation where metastasis in the pancreas should be suspected strongly. ERCP with EUS guided pancreas biopsy or adjacent lymph nodes biopsy can make the diagnosis. As the treatment for transitional cell carcinoma is different from cholangiocarcinoma or pancreatic cancer, it is important to make the correct diagnosis.
High-grade CBD stricture
Heterogenous pancreatic head mass measuring up to 3.5cm with downstream pancreatic ductal distention to 3mm with associated cut off at the pancreatic neck
Disclosures: Ji Seok Park indicated no relevant financial relationships. Sang Min Chang indicated no relevant financial relationships. Sandarsh Kancherla indicated no relevant financial relationships.