review of literature on clinical pancreatology - The Pancreapedia

Colorectal carcinomaPancreatic metastases from colorectal cancer are very rare, and the possible benefit <strong>of</strong>surgical treatment is not clearly defined. One study was designed to evaluate the outcome <strong>of</strong>patients undergoing pancreatic resection for metastatic colorectal cancer to the pancreas.Nine patients underwent pancreatic resection for metastatic colorectal cancer between 1980and 2006. The primary cancers were colon (n=7) and rectal carcinoma (n=2). The medianinterval between primary treatment and detection <strong>of</strong> pancreatic metastases was 33 months.In three cases pancreatic metastases were synchronous with the primary tumor. Fivepatients underwent pancreaticoduodenectomy, and four underwent distal pancreatectomy. Aleft lateral liver section and three colon resections were simultaneously performed in fourpatients. There was no postoperative mortality, and only two patients experiencedcomplications. Survival averaged 20 (median, 17; range, 5-30) months: seven patients died<strong>of</strong> metastatic disease, one for unrelated disease after five months, and one is alive with livermetastases 30 months after surgery. The authors concluded that surgical resection can beperformed safely in patients with isolated pancreatic metastases from colorectal cancer andin selected patients with associated extrapancreatic disease. Although long-term survival israre, surgery should be included, whenever possible, in the multimodality approach to thisdisease [632].Bronchial carcinomaIt was described the case <strong>of</strong> a 60 year old female smoker who presented with a three monthhistory <strong>of</strong> weight loss (14 Kg), generalized abdominal discomfort and malaise. Chestradiography demonstrated a mass projected inferior to the hilum <strong>of</strong> the right lung. ComputedTomography <strong>of</strong> thorax confirmed a lobulated lesion in the right infrahilar region andsubsequent staging abdominal CT demonstrated a low density lesion in the neck <strong>of</strong> thepancreas. Percutaneous ultrasound guided pancreatic biopsy was performed, histology <strong>of</strong>which demonstrated pancreatic tissue containing a highly necrotic small cell undifferentiatedcarcinoma consistent with metastatic small cell carcinoma <strong>of</strong> the bronchus [633].Hepatocellular carcinomaFibrolamellar carcinoma is a subtype <strong>of</strong> hepatocellular carcinoma with distinctclinicopathologic features including presentation at a younger age. Although early studiessuggested that fibrolamellar carcinoma had a better prognosis than conventionalhepatocellular carcinoma, most later studies have found no difference. Patients <strong>of</strong>ten havelymph node metastases at presentation in addition to the hepatic primary. It was describedan unusual case in a Thai boy who presented with a pancreatic mass that was clinicallysuspected to be a primary pancreatic tumor, but on biopsy was found to be metastaticfibrolamellar carcinoma. This manner <strong>of</strong> presentation has not been previously reported forfibrolamellar carcinoma, nor has metastatic spread to the pancreas [634].Diffuse retroperitoneal cystic abdominal lymphangiomatosisAttributed to congenital malformation <strong>of</strong> lymphatic ducts, diffuse retroperitoneal cysticabdominal lymphangiomatosis has a distribution that <strong>of</strong>ten corresponds to the location <strong>of</strong>primitive fetal lymphatic sacs. Three recognized types are capillary, cavernous and cystic.Multisystem involvement may occur involving spleen, liver, bone, pancreas, s<strong>of</strong>t tissue, limbsand brain. Now a 55-year-old, healthy male with multiple liver lesions and retroperitoneallymphadenopathy presented for retroperitoneal fine needle aspiration, producing 20 mL <strong>of</strong>milky liquid. Immediate cytologic evaluation showed a heterologous population <strong>of</strong> maturelymphocytes with chylomicrons. Flow cytometry revealed a polyclonal population <strong>of</strong> maturelymphocytes. Chemical analysis demonstrated a normal serum cholesterol level and an