C0052 - Pancreatic Adenocarcinoma With Duodenal Metastasis Presenting as Acute Pancreatitis

Introduction: Pancreatic carcinomas account for 3% of all cancers in the United States and are usually adenocarcinomas. Patients commonly present with fatigue, weight loss, and abdominal pain. We present a rare case of pancreatic adenocarcinoma with duodenal metastasis presenting as acute pancreatitis.

Case Description/Methods: A 65-year-old female with PMHx of hypertension and alcohol use presented to the ED with acute epigastric pain. Lab work revealed a lipase level of 5,800. CT scan revealed findings consistent with acute pancreatitis and inflammation in the duodenum. She was started on intravenous fluids and had improvement in symptoms. She then had sudden onset of abdominal pain, rising liver function tests, and fever after a few days. HIDA scan was negative for acute pathology. An EUS and ERCP revealed a lesion in the ampulla of vater and a 1 x 1.1 cm mass in the uncinate process of the pancreas. Biopsy of the duodenal and pancreatic masses revealed poorly differentiated adenocarcinoma with signet-ring features. Patient was discharged to home and followed up outpatient with gastroenterology.

Discussion: Pancreatic carcinomas (PC) can be composed of exocrine or endocrine cells. Over 95% of PC are exocrine and, of these, 95% are adenocarcinomas. The only potentially curative treatment is surgical resection. Due to late presentation, only 15-20% of patients are surgical candidates. The 5-year survival rate after complete resection is 30% for node-negative disease and 10% for node-positive disease. PC usually metastasizes to the liver, peritoneum, and lungs, and rarely metastasizes to the duodenum. Patients commonly present with insidious epigastric abdominal pain radiating to the back. PC can uncommonly present as an episode of acute pancreatitis and studies have found that patients with this presentation may have a survival advantage due to an earlier stage at diagnosis [1]. As such, pancreatic adenocarcinoma should be considered in patients presenting with idiopathic acute pancreatitis, and duodenal metastasis should be considered in patients with pancreatic adenocarcinoma.



References:
1. Dzeletovic, I, et al. Pancreatitis before Pancreatic Cancer. J Clin Gastroenterol. 2014; 48(9): 801-805