Metastatic pancreatic adenocarcinoma presenting as an occipital haemorrhage

Abstract

We report a case of a 63-year-old woman who was presented to the emergency department with an occipital haemorrhage secondary to a pancreatic cerebral metastasis. Pancreatic cancer is the ninth most common cancer in women in Australia, and distant disease is present in 70% of patients with pancreatic cancer at the time of diagnosis. However, metastases to the brain are rare, accounting for only 0.33%-0.57% cases antemortem. Herein, we discuss the management of this unusual case to highlight the importance of recognising unusual central nervous system involvement of cancers, a problem which may be increasing in prevalence.

Keywords: gastrointestinal surgery; neurosurgery; pancreas and biliary tract.

Figure 1

Initial MRI T2 fluid-attenuated inversion recovery.

Figure 2

MRI fluid-attenuated inversion recovery showing progression of lesion and increased amount of oedema and cystic enhancement.

Figure 3

Poorly defined, infiltrating soft tissue mass centred on the uncinate process of pancreas, displaying pathological uptake of fludeoxyglucose (41 mm diameter; SUVmax 9.0) consistent with a primary infiltrating lesion.

Figure 4

Fine needle aspiration pancreas ×40 clusters of large epithelial cells present showing mild to moderate atypia, some of which appear papillary and some of which are present in cohesive clusters.

Figure 5

Metastasis to brain ×5: cerebral parenchyma infiltrated by metastatic adenocarcinoma.

Figure 6

Metastasis to brain ×10: cystically dilated glands lined by atypical columnar mucinous type epithelium with small islands and clusters of cells infiltrating the adjacent cerebral parenchyma.