The medical literature indicates that pancreatic adenocarcinoma is the most common type of pancreatic cancer.
Xial T1-weighted magnetic resonance imaging sequence depicting a homogeneous tumor with low signal intensity (white arrow). Photo: Courtesy of the researchers in the study.
This is a case that surprised the clinicians who treated the patient, as soft tissue metastases of a primary carcinoma are rare lesions and are often the first clinical manifestation of a previously unknown late-stage malignancy presenting in isolation against a background of recurrent disease.
They emphasized that pancreatic adenocarcinoma soft tissue metastases are extremely rare, even mentioning that some cases of skin involvement have been described in the literature, and solitary metastases to deep soft tissues (eg, subcutaneous tissue and skeletal muscle) have also been reported. 10 times.
A case presented in a 74-year-old woman with late subcutaneous metastases (relapse of the disease), solitary in the back of the left thigh, derived from pancreatic head adenocarcinoma, 2 years after initial treatment with R0 resection or pancreatoduodenectomy, a procedure performed to treat tumors and diseases associated with the intestines, pancreas and bile ducts, or adjuvant chemotherapy.
As stated in the published study, these scenarios are associated with a poor prognosis and can be a source of diagnostic confusion from both a clinical and pathological point of view. “The main localization of a malignant neoplasm is usually the lungs, mammary gland, kidneys or large intestine,” they note.
The investigators emphasize that due to the rarity of this lesion, they reviewed the literature and discussed treatment options, taking into account our patient’s good general condition and symptoms (local pain), favorable location (thigh), and small tumor size. (less than 4 cm in diameter) and the absence of disease recurrence at additional sites, it was decided to perform an excisional biopsy of the focus instead of a core biopsy.
Histopathological analysis of the sample revealed a metastatic lesion of adenocarcinoma, therefore, in addition, the investigators considered additional immunohistochemical analysis to be unnecessary due to the patient’s history (known adenocarcinoma of the pancreas).
“Although distant metastases of pancreatic adenocarcinoma generally have a poor prognosis, there is insufficient data in the literature on the path, treatment, and prognosis of isolated distant soft tissue metastasis due to the rarity of this metastatic entity,” they described. .
In order to alleviate the patient’s symptoms, the specialists indicated that additional chemotherapy appears to be an ideal treatment option. “Whether this choice will also lead to an increase in life expectancy has not yet been taken into account, but after 8 months our patient remains healthy,” they note.
Thus, soft tissue metastasis of primary carcinoma is rare, and in most cases, the primary malignancy is lung, kidney, or colon carcinoma.
Another aspect highlighted is that while hematogenous spread of pancreatic adenocarcinoma is usually associated with a poor prognosis, cases like ours “demonstrate the importance of resection of the lesion for diagnostic and palliative purposes, and for life prolongation seems to be a reasonable treatment option.”
Case access here.