A case of successfully resected metachronous gastric and gallbladder metastases from pancreatic body cancer

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) readily metastasizes to the lymph nodes, liver, lung, and peritoneum; however, gastric and gallbladder metastases are rare. We report a case of metachronous gastric and gallbladder metastases from PDAC.

Case presentation: The patient is a 71-year-old man who underwent distal pancreatectomy for PDAC. Seventeen months after the surgery, a 30-mm nodule was detected at the lesser curvature of the stomach, which was diagnosed as recurrence of PDAC in the lymph nodes. He then received gemcitabine and S-1 combination chemotherapy for 6 months. Because tumor size remained approximately the same and tumor marker levels decreased, total gastrectomy and cholecystectomy were performed. Pathological examination showed well-differentiated tubular adenocarcinoma in the subserosa and muscularis propria of the stomach and gallbladder. The patient remains alive at 41 months after the second surgery with liver metastasis.

Conclusion: We reported a rare case of metachronous gastric and gallbladder metastases from pancreatic body cancer.

Keywords: Metachronous gallbladder metastasis; Metachronous gastric metastasis; Pancreatic cancer; Surgery.

Fig. 1

Primary operation for pancreatic body cancer. a Multi-detector row computed tomography (MDCT) showed pancreatic body cancer before the first surgery (arrows). b Pathological findings of the primary tumor were as follows: invasive ductal carcinoma, well-differentiated type, and (T3, N0, M0) stage IIa

Fig. 2

Imaging diagnosis of recurrence. a MDCT showed a 30-mm nodule at the lesser curvature of the stomach. b Positron emission tomography (PET)/CT showed fluorodeoxyglucose (FDG) uptake in the nodule; SUVmax was 3.5. c Upper gastrointestinal endoscopy revealed mucosal irregularity in the posterior wall of the lesser curvature of the gastric body (arrow). d Upper gastrointestinal endoscopy revealed submucosal tumor in the anterior wall of the gastric antrum (arrowhead)

Fig. 3

Histological findings of metastases. a Macroscopic findings in the stomach. There were two lesions in the stomach wall (arrow: lesser curvature (25 × 20 mm), arrowhead: anterior wall of antrum (15 × 13 mm). b Pathological examination showed well-differentiated tubular adenocarcinoma in the subserosa and muscularis propria of the stomach; the tumor was not exposed to the mucosa and serosa (arrow), and there was no involvement of lymph nodes. c Macroscopic finding in the gallbladder. A 13 × 5-mm submucosal tumor was found in the neck of the gallbladder (arrow). d Well-differentiated tubular adenocarcinoma located in the subserosa of the gallbladder (arrow)