Jennifer Yoon, MD1, Arpine Petrosyan, MD2, Timothy Wang, MD2, Adnan Ameer, MD3 1UCSF Fresno, Fresno, CA; 2University of California San Francisco Fresno, Fresno, CA; 3UCSF Fresno/CCFMG, Fresno, CA
Introduction: Colorectal cancer most commonly metastasizes to the regional lymph nodes, liver, bone, lungs, and peritoneum. Pancreatic metastasis from colon cancer is rare, and cases of solitary synchronous pancreatic metastasis are exceedingly limited in the literature. We present the youngest reported case of metastatic colon adenocarcinoma with synchronous metastasis to the pancreas.
Case Description/Methods: A 33-year-old male with a history of alcohol and tobacco abuse presented with intractable abdominal pain associated with a 35-pound weight loss. He had a palpable firmness in the right upper quadrant with overlying tenderness. He had elevated liver enzymes in a cholestatic pattern and markedly elevated CEA and CA 19-9. Computed tomography (CT) showed a pancreatic head mass with intrahepatic biliary dilation, two hepatic masses, and a large apple core, non-obstructive mass in the transverse colon (Figure 1). EUS-guided biopsy of the pancreatic head mass and ERCP with biliary stent placement were performed. Histology confirmed colon adenocarcinoma. Colonoscopy demonstrated a partially obstructing tumor in the transverse colon with pathology positive for moderately differentiated adenocarcinoma. Genetic testing was performed but was negative.
Discussion: Metastasis of colorectal cancer occurs via the lymphatics, direct invasion, and along blood vessels. Due to this mechanism of spread, metastatic lesion to the pancreas (PMET) of colorectal origin are unusual and encompass 0.5-5% of all pancreatic malignancies. PMETs are commonly diagnosed on surveillance imaging after treatment of the primary cancer. Typical findings on EUS of a metastatic pancreatic lesion is a hypoechoic and heterogeneous mass with well-defined margins most frequently located within the head of the pancreas. Our case is unique due to the rare presentation as well as the patient’s young age. While solitary pancreatic lesions are usually a primary process, metastatic disease should always be considered. Distinguishing between the two is crucial for disease management.
Figure: Figure 1: A. Computed tomography (CT) scan showing large apple core, non-obstructive mass in proximal transverse colon. B/C. CT scan demonstrating pancreatic head mass. D. Colonoscopy showing partially obstructing mass with abnormal, ulcerated mucosa in the proximal transverse colon. E. Endoscopic ultrasound (EUS) showed irregular, hypoechoic, heterogeneous lesion with portal vein invasion. Staged T3N2MX.
Jennifer Yoon indicated no relevant financial relationships.
Arpine Petrosyan indicated no relevant financial relationships.
Timothy Wang indicated no relevant financial relationships.
Adnan Ameer indicated no relevant financial relationships.
Jennifer Yoon, MD1, Arpine Petrosyan, MD2, Timothy Wang, MD2, Adnan Ameer, MD3. P2140 - Youngest Reported Case of Colonic Adenocarcinoma With Synchronous Metastasis to the Pancreas, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.