Pancreatic metastases to the rectum: a case report and literature review

Figures & data

Figure 1. Contrast-enhanced computed tomography (CT) scan. CT scan showed retroperitoneal masses involved in the pancreatic tail surrounding adjacent blood vessels (A) and a mass in rectum (B).

Figure 2. Photomicrographs (×100). Immunohistochemical stains of pancreatic tissue showed that cancer cells were strongly positive for CK-7 (A) but negative for CK-20 (B) and CDX2 (C).

Table 1. Reports of pancreatic metastases to colorectum.

Author/reported years	Age	Gender	Clinical history	IHC	Regimen	Outcome
Ohara et al. (2018)	67	Male	After 24 and 28 months of PACC resection, the patient developed liver and rectum metastases.	Pancreatic and rectal tissues: CK-7: + CK-19: + CK-20: − CDX2: −	Adjuvant chemotherapy of S-1 for 11 months after PACC resection. No additional chemotherapy after abdominoperineal resection of metastases.	No tumor recurrence was observed after a median follow-up of 40 months.
Park et al. (2019)	73	Female	The patient developed a colonic obstruction first and a subtotal colectomy. CT scans identified a mass in the pancreatic body. IHC was performed on both colonic lesion and pancreatic mass.	Pancreatic tissue: CK-7: + CK-20: +/− CDX2: − Colonic tissue: CK-7: + CK-20: +/− CDX2: − SATB2: −	Cemcitabine and nab-paclitaxel.	The patient died after 7 months.
Nogueira et al. (2018)	60	Male	The patient was misdiagnosed as colon cancer first. Pathology confirmed the mass was pancreatic metastasis to colon.	Umbilical nodule: CK-7: + CK-20: − CDX2: − Pancreatic biopsy: dismissed	After 2 cycles of FOLFOX regimen, the patient received a laparotomy due to Intestinal perforation. FOLFOX regimen was given again after surgery.	The patient died 9 months after CT.
Inada et al. (2013)	62	Male	Seven years after pancreatoduodenectomy, the patient presented with bowel obstruction and received a right hemicolectomy. IHC showed it was a metastasis from a primary pancreatic cancer.	Pancreatic tumor: CK-7: + CK-20: − Colon tumor: CK-7: + CK-20: −	Seven cycles of gemcitabine (1000 mg/m^2)	The patient died 14 months after surgery.
Bellows et al. (2009)	45	Male	CT and colonoscopy showed mass in ascending colon. After a right hemicolectomy, IHC documented that the lesion was a metastasis from pancreas.	CA199, CAM 5.2, CEA, EMA: + CDX2, CK-20, CK-7, CD10, vimentin, TTF-1:−	NA	NA
Kahl et al. (2019)	91	Female	Sigmoidoscopy found severe stenosis, and CT revealed pancreatic head mass. IHC showed the primary site was pancreas.	CK-7: + CK-20: − CDX2: −	Palliative care	NA
Kim and Lee (2015)	64	Male	The patient developed colonic metastasis of pancreatic cancer 2 years after distal pancreatectomy. Subsequent right hemicolectomy was done.	Colon tumor: CK-7: + CK-19: − CK-20: −	He had regular follow-ups after pancreatectomy and treated with gemcitabine after hemicolectomy.	The patient still alive 6 months after diagnosis
Miyasaka et al. (2018)	63	Male	Three months after pancreatoduodenectomy, CT scan revealed masses in colon. After partial resection of the mass, pathology confirmed the mass was pancreatic metastasis to colon.	NA	Nab-paclitaxel with gemcitabine for 2 months and best supportive care after this.	The patient died 7 months after surgery.
Fukatsu et al. (2009)	87	Male	Colonoscopy showed mucosal fold convergence in rectum while CT scan showed a tumor in pancreas and multiple metastatic mass in liver and omentum.	Biopsy specimens from rectum: CK-7: + CK-20: − PSA: −	Best supportive care	NA

IHC: immunohistochemistry; CT: chemotherapy; PACC: pancreatic acinar cell carcinoma.

Ohara Y, Oda T, Enomoto T, Hisakura K, Akashi Y, Ogawa K, Owada Y, Domoto Y, Miyazaki Y, Shimomura O, et al. 2018. Surgical resection of hepatic and rectal metastases of pancreatic acinar cell carcinoma (PACC): a case report. World J Surg Oncol. 16(1):158.

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Park DY, Krishnamurthi S, Chahal P, Downs-Kelly E, Morris-Stiff G. 2019. Pancreatic metastases to the colon: an unusual cause of colonic obstruction. BMJ Case Rep. 12(11):e228578.

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Miyasaka M, Noji T, Tanaka K, Nakanishi Y, Asano T, Ebihara Y, Kurashima Y, Nakamura T, Murakami S, Tsuchikawa T, et al. 2018. Oncological emergency surgery for metachronous large and small bowel metastases after pancreaticoduodenectomy for pancreatic cancer: a case report. Surg Case Rep. 4(1):99.

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Data availability statement

The data and materials supporting this study are available, without breaching participant confidentiality, in the figshare repository (https://figshare.com/articles/figure/Figures/21304122).