Pancreatic cancer presenting as colonic disease. A rare case report

Abstract

Introduction: Pancreatic cancer is the fourth major cause of cancer-related deaths. About 50% of the patients are diagnosed with advanced disease. Metastatic disease to the colon is a very rare entity with only 5 cases described in english literature.

Case presentation: Male, 60 years-old, presents to a surgical consult with the diagnosis of an adenocarcinoma of the sigmoid colon. The physical exam revealed a periumbilical nodule with suspicious features. The staging CT-scan showed a mass in the tail of the pancreas involving the spleen and left kidney, thickening of the sigmoid colon, multiple mesenteric masses and trabecular changes in the ischium, suggesting metastatic disease. The case was discussed by a multidisciplinary team and it was decided to do a biopsy of the umbilical nodule and review the specimen obtained in colonoscopy. Pathological analysis revealed a metastasis from pancreatic adenocarcinoma. The patient was proposed to start palliative chemotherapy for metastatic pancreatic cancer. After 2 cycles of FOLFOX the patient was admitted in the OR with a perforation of the sigmoid mass. He was submitted to a sigmoidectomy with end colostomy, with discharge at the 5th postoperative day. Pathological analysis of the specimen confirmed the pancreatic origin of the tumor. Patient proceeded with palliative treatment, with death 9 months after the diagnosis.

Discussion: Pancreatic metastasis to the colon is a very rare entity. Care should be taken when addressing these patients.

Conclusion: Although rare, a sigmoid tumor in a patient with known pancreatic adenocarcinoma must raise the suspicion of metastasis.

Keywords: Cancer; Case report; Colon; Metastasis; Pancreas; Perforation.

Fig. 1

Staging CT-Scan: Tumor of the tail of the pancreas invading the spleen (marked with a red arrow).

Fig. 2

Pathological analysis of the umbilical nodule: A–Hematoxylin-eosin 40×; B–Hematoxylin-eosin 100×. The images show an adenocarcinoma composed of small and medium-sized glandular structures with pleomorphic nuclei with desmoplastic stroma.

Fig. 3

Emergency department CT-Scan, no contrast administration due to renal insufficiency: A–Thickening of sigmoid colon with signs of perforation (marked with the red arrow).