A Surgical Case of Pancreatic Metastasis from Lung Cancer

Abstract

Introduction Most patients with pancreatic metastasis from lung cancer are not candidates for surgical treatment because they have widespread systemic disease at the time of diagnosis. But it was reported that some patients with long-term survival were resected for pancreatic metastasis from lung cancer. We herein report a surgical case of pancreatic metastasis from lung cancer. Case Presentation A 61-year-old man was admitted to our hospital because of a lung tumor. He underwent right middle lobectomy. A histopathologic examination showed poorly differentiated adenocarcinoma. About 1 year after lung resection, brain metastasis was demonstrated and radiation therapy was subsequently performed. Seven years after lung resection, his serum carcinoembryonic antigen levels were again elevated. FDG–PET (fluorodeoxyglucose-positron emission tomography) showed a slight uptake by the pancreatic head. Computed tomography (CT) showed an irregular and poorly enhanced tumor in the pancreatic head. EUS–FNA (endoscopic ultrasonography fine-needle aspiration) of the tumor in the pancreatic head was performed. A histopathologic examination showed thyroid transcription factor (TTF)-1 positive adenocarcinoma. The preoperative diagnosis was pancreatic metastasis from lung cancer. We performed subtotal stomach-preserving pancreaticoduodenectomy for the pancreatic head tumor because the primary lung cancer and brain metastasis responded to chemoradiation. A histopathologic examination of the resected specimen revealed moderately differentiated adenocarcinoma. Immunohistochemistry revealed TTF-1 positive cells in the tumor. The patient was discharged from the hospital on the 12th day after surgery. He is currently alive 22 months after pancreatic surgery. Conclusion Resection of pancreatic metastasis from lung cancer may improve the patient outcome when the metastasis is localized in the pancreas or other organ metastases are controlled.