Pancreatic metastasis of renal cell carcinoma

BACKGROUND： Renal cell carcinoma （RCC） is a common cancer, but pancreatic metastasis of RCC is unusual. Because of the rarity and peculiarity, pancreatic lesions from RCC metastasis were described mostly in case reports which highlight the importance of a systematic analysis of this clinical condition. DATA SOURCES： Data of 7 patients with pancreatic metastasis of RCC treated in the Peking Union Medical College Hospital were extracted and 193 similar patients reported in the past 10 years from the literature were analyzed. Epidemiological, pathological and follow-up information were investigated. Po- tential prognostic factors were compared with corresponding data reported 10 years ago. RESULTS： Multivariate Cox regression showed that asymp- tomatic metastasis and surgical procedure were independent factors associated with better survival. Compared with the data reported 10 years ago, follow-up of RCC patients has been emphasized in recent years, and atypical surgery is frequently used since it has similar effect as typical surgery on tumor resection while it is able to preserve more pancreatic function. CONCLUSION： Surgical treatment should be an option as long as the pancreatic metastasis of RCC is resectable.

Case of pancreatic metastasis from colon cancer in which cell block using the Trefle^■ endoscopic scraper enables differential diagnosis from pancreatic cancer

Endoscopic transpapillary brush cytology and forceps biopsy during endoscopic retrograde cholangiopancreatology are generally used to obtain pathological evidence of biliary strictures. Recently, the new endoscopic scraper Trefle~? has been reported and demonstrated high cancer detectability in malignant biliary strictures. This device is used to scrape the stricture over the guidewire, and, in the original method, the tissue and/or cell samples obtained are subjected to histological and/or cytological analysis separately. However, discrimination of chunks of tissue is hampered by the opacity of the surrounding fluid. We have developed a cell block technique for the Trefle~? device without dividing obtained specimens into tissue and cellular components, which is the simplest method and enables immunohistochemical analysis. We present a case of obstructive jaundice diagnosed immunohistochemically as pancreatic metastasis from colon cancer using cell block sections obtained with the Trefle~? device, which procedure is as easy as conventional brush cytology.

Solitary pancreatic metastasis from squamous cell lung carcinoma: A case report and review of literature

BACKGROUND Pancreatic metastases from squamous cell lung carcinoma(SCLC)are unusual.These lesions are often asymptomatic and detected incidentally or during followup investigations,occasionally several years after removal of the primary tumor.CASE SUMMARY A 56-year-old male with SCLC developed jaundice 1 mo after the cancer diagnosis.An abdominal computed tomography(CT)scan showed a mass in the pancreatic head with distention of both intra-and extrahepatic biliary ducts.Endoscopic retrograde cholangiopancreatography and sphincterotomy were performed first,culminating with plastic biliary stent placement.Cytological examination of the pancreatic mass sample collected by fine-needle aspiration(FNA)under endoscopic ultrasound(EUS)guidance revealed the presence of malignant cells compatible with well-differentiated squamous cell carcinoma.After liver function normalized,chemotherapy was initiated with carboplatin and paclitaxel;however,4 d later,the patient presented dysphagia.Cervico-thoracoabdominal CT showed tracheoesophageal fistula and stent migration.After replacement with a 10 cm/10 mm uncovered metallic biliary stent and treatment of the tracheoesophageal fistula with a fully covered esophageal stent,the patient was able to start oral feeding progressively.He died 9 mo after the initial diagnosis.CONCLUSION The diagnosis of pancreatic metastasis from SCLC is challenging for clinicians.EUS-FNA is the primary exam for confirmatory diagnosis.

Advances in understanding the molecular mechanism of pancreatic cancer metastasis

BACKGROUND： Pancreatic cancer（PC） is usually diagnosed at the late-stage and therefore, has widespread metastasis and a very high mortality rate. The mechanisms underlying PC metastasis are not well understood. Recent advances in genomic sequencing have identified groups of gene mutations that affect PC metastasis, but studies elucidating their roles are lacking. The present review was to investigate the molecular mechanisms of PC metastasis.DATA SOURCES： Relevant articles on PC metastasis were searched in MEDLINE via Pub Med prior to April 2015. The search was limited in English publications.RESULTS： PC metastatic cascades are multi-factorial events including both intrinsic and extrinsic elements. This review highlights the most important genetic alterations and other mechanisms that account for PC invasion and metastasis, with particular regard to epithelial-mesenchymal transition, inflammation, stress response, and circulating tumor cells.CONCLUSIONS： Analyses of relevant gene functions and signaling pathways are needed to establish the gene regulatory network and to define the pivotal modulators. Another promising area of study is the genotyping and phenotyping of circulating tumor cells, which could lead to a new era of personalized therapy by identifying specific markers and targets.

Surgery for oligometastasis of pancreatic cancer

The incidence of pancreatic adenocarcinoma（PDAC） has steadily increased over the past several decades. The majority of PDAC patients will present with distant metastases, limiting surgical management in this population. Hepatectomy and pulmonary metastasectomy（PM） has been well established for colorectal cancer patients with isolated, resectable hepatic or pulmonary metastatic disease. Recent advancements in effective systemic therapy for PDAC have led to the selection of certain patients where metastectomy may be potentially indicated. However, the indication for resection of oligometastases in PDAC is not well defined. This review will discuss the current literature on the surgical management of metastatic disease for PDAC with a specific focus on surgical resection for isolated hepatic and pulmonary metastases.

Irreversible electroporation for liver metastasis from pancreatic cancer: A case report

BACKGROUND Pancreatic cancer has a poor prognosis;40%–50% of patients have liver metastases at the time of initial diagnosis and only 15%–20% undergo surgical resection. Irreversible electroporation(IRE) is a new, non-thermal local ablation method for solid tumors, which can induce cell membrane permeabilization,resulting in unrecoverable nanoscale perforation and apoptotic cell death without damaging the structural components of tissues.CASE SUMMARY We report the case of a 66-year-old female patient with liver metastasis from pancreatic cancer with a pathological diagnosis of poorly differentiated adenocarcinoma. Carbohydrate antigen 19-9 was elevated to 420.3 U/m L.Computed tomography showed a pancreas mass of 2.7 cm × 2.5 cm and single liver metastasis of 1.4 cm × 1.1 cm in the S6 area. The patient underwent IRE and arterial infusion chemotherapy and received tegafur. The therapeutic effect of the combination treatment has been evaluated as complete response. To date, the patient has survived for > 12 mo and is receiving tegafur as maintenance therapy(at the time this case report was written).CONCLUSION IRE plus arterial infusion chemotherapy and tegafur may be synergistic,providing a reference for treating liver metastasis from pancreatic cancer.

Clear cell sarcoma metastasizing to the pancreas

In this editorial based on a case report,we delve into a seldom-seen occurrence of clear cell sarcoma featuring pancreatic metastasis in a 47-year-old male patient.Recognized for its typical tendency to metastasize to the lungs,bones,and brain,clear cell sarcoma rarely extends its reach to the pancreas.Despite the initial absence of discernible abnormalities during the patient's physical examination,the manifestation of abdominal pain prompted further investigation.Subsequent abdominal computed tomography brought to light the presence of a pancreatic tumor,culminating in the definitive diagnosis of clear cell sarcoma with pancreatic metastasis.The successful management of this atypical presentation involved a series of surgical interventions,including distal pancreatectomy and splenectomy.This report not only sheds light on the infrequent manifestation of clear cell sarcoma within the pancreas but also underscores the pivotal role of vigilant postoperative follow-up in addressing this rare sarcoma.The emphasis on postoperative care serves as a crucial aspect of the broader narrative,acknowledging the need for ongoing monitoring and management to ensure a comprehensive and successful treatment trajectory for patients with this unique presentation of clear cell sarcoma.

Could the burden of pancreatic cancer originate in childhood?

The presence of pancreatic cancer during childhood is extremely rare,and physicians may be tempted to overlook this diagnosis based on age criteria.However,there are primary malignant pancreatic tumors encountered in pediatric patients,such as pancreatoblastoma,and tumors considered benign in general but may present a malignant potential,such as the solid pseudo-papillary tumor,insulinoma,gastrinoma,and vasoactive intestinal peptide secreting tumor.Their early diagnosis and management are of paramount importance since the survival rates tend to differ for various types of these conditions.Many pediatric cancers may present pancreatic metastases,such as renal cell carcinoma,which may evolve with pancreatic metastatic disease even after two or more decades.Several childhood diseases may create a predisposition for the development of pancreatic cancer during adulthood;hence,there is a need for extensive screening strategies and complex programs to facilitate the transition from pediatric to adult healthcare.Nevertheless,genetic studies highlight the fact the specific gene mutations and family aggregations may be correlated with a special predisposition towards pancreatic cancer.This review aims to report the main pancreatic cancers diagnosed during childhood,the most important childhood diseases predisposing to the development of pancreatic malignancies,and the gene mutations associates with pancreatic malignant tumors.

Discovery of a potent and highly selective inhibitor of SIRT6 against pancreatic cancer metastasis in vivo

Pancreatic cancer,one of the most aggressive malignancies,has no effective treatment due to the lack of targets and drugs related to tumour metastasis.SIRT6 can promote the migration of pancreatic cancer and could be a potential target for antimetastasis of pancreatic cancer.However,highly selective and potency SIRT6 inhibitor that can be used in vivo is yet to be discovered.Here,we developed a noveSIRT6 allosteric inhibitor,compound 11e,with maximal inhibitory potency and an IC_(50) value of 0.98±0.13μmol/L.Moreover,compound 11e exhibited significant selectivity against other histone deacetylases(HADC1-11 and SIRT1-3)at concentrations up to 100μmol/L.The allosteric site and the molecular mechanism of inhibition were extensively elucidated by cocrystal complex structure and dynamic structural analyses.Importantly,we confirmed the antimetastatic function of such inhibitors in four pancreatic cancer cell lines as well as in two mouse models of pancreatic cancer liver metastasis.To our knowledge,this is the first study to reveal the in vivo effects of SIRT6 inhibitors on liver metastatic pancreatic cancer.It not only provides a promising lead compound for subsequent inhibitor developmentargeting SIRT6 but also provides a potential approach to address the challenge of metastasis in pancreatic cancer.

Metachronous pulmonary and pancreatic metastases arising from sigmoid colon cancer:A case report

BACKGROUND Metachronous pulmonary and pancreatic metastases from colorectal cancer are rare.The diagnosis of pancreatic metastases is difficult and predominantly relies on computed tomography,pathology and immunohistochemistry.Here,we describe the use of next-generation sequencing(NGS)for determination of the origin of metastasis and prognostic prediction of colorectal cancer.CASE SUMMARY A 59-year-old man was diagnosed with sigmoid adenocarcinoma stage IIA(T3N0M0)and underwent surgery in April 2014,followed by XELOX adjuvant chemotherapy.The patient developed pulmonary metastasis in the right upper lung and underwent surgery in May 2016 without further adjuvant chemotherapy.In May 2018,pancreatic metastasis was found and he underwent pancreaticoduodenectomy.After surgery,he was treated with adjuvant S-1 chemotherapy from June 2018 to March 2019.Histopathological review of the specimens from all three lesions indicated consistent patterns characteristic of colon cancer.Concordant gene mutation profiles were observed across the three lesions that included oncogenic driver mutations most frequently seen in colon cancer(e.g.,APC,TP53,KRAS and FBXW7).Blood circulating tumor(ct)DNA before adjuvant chemotherapy was undetectable with NGS,suggesting a favorable response to chemotherapy.The patient was alive and well at the latest follow-up visit,achieving a disease-free survival of 17 mo.CONCLUSION The genetic profiles of primary tumor,metastases and ctDNA may have clinical value in auxiliary diagnosis,prognosis and therapeutic decision-making.

Liver metastasis of pancreatic cancer: the new choice at the crossroads

In recent years,the incidence of pancreatic cancer has increased markedly both in China and internationally.For patients with pancreatic cancer,surgical resection remains the only effective method of obtaining a cure and long-term survival,although only few patients can expect this benefit.