RESUMO
CONTEXT: Primary lung cancer frequently metastasizes to distant organs; however, the pancreas is a relatively infrequent site of metastasis. Because most metastatic cases in the pancreas tend to be discovered in patients only after malignant disease has become widely disseminated, it is extremely rare that a metachronous metastatic lesion limited to the pancreas is discovered with postoperative imaging and is surgically resectable. Most patients demonstrate accompanying metastases to other organs, especially in cases of lung cancer, which prove to be surgically unresectable when diagnosed. Although several cases have been reported of patients who underwent pancreatic resection for curative intent, most patients died from recurrent disease. CASE REPORT: We report herein an unusual case of secondary tumor of the pancreas (primary tumor: adenocarcinoma of the lung) with hopefully curative resection. The interval between the surgical treatment of lung cancer and the metachronous pancreatic metastasis was 22 months; there has been no recurrence of disease during the 24 months of follow-up after a pylorus-preserving pancreaticoduodenectomy. CONCLUSION: Surgical treatment should be considered in patients with pancreatic metastasis from other organs if the disease is localized in the pancreas or if metastasis in other organs is controlled with chemotherapy and/or radiotherapy.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Dor nas Costas/etiologia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias Pancreáticas/secundário , Neoplasias Pancreáticas/cirurgia , Recidiva , Dor de Ombro/etiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Cowden syndrome (CS), also known as multiple hamartoma syndrome, is an autosomal dominant cancer syndrome associated with high risk of breast and thyroid cancer. In three unrelated Japanese CS patients, three PTEN germline mutations were identified, including two novel ones: 589A --> T, resulting in Lys197Stop, and 219-222delAAGA. We also detected a previously reported mutation: 697C --> T, resulting in Arg233Stop. Reports from Western countries have indicated that approximately two-thirds of mutations are found in exons 5, 7, and 8, which is almost the same frequency as found in Japanese CS. No genotype-phenotype correlations have been found in CS patients from 21 Japanese families.