A Woman with Remotely Treated Pancreas Cancer and New Abdominal Pain: A Discussion of Evaluation and Management

Excerpt

Dr. Epstein (New York): A 70-year-old woman with a remotely treated exocrine pancreas cancer presented with right upper quadrant abdominal pain. A CT scan of the abdomen and pelvis revealed multiple bilobar liver lesions of various sizes from 1.3 to 4.9 cm in diameter, new since a scan performed a few years previously (Fig. 1). The patient’s pancreas cancer, diagnosed as adenocarcinoma at that time, was resected 25 years ago at Memorial Sloan-Kettering Cancer Center (MSKCC), treated with adjuvant chemoradiation post-operatively, and then followed regularly without evidence of disease thereafter. In light of the new CT findings, a CT-guided liver biopsy was performed at an outside institution, demonstrating poorly differentiated carcinoma. Immunohistochemical staining revealed strongly positive CK7, MOC-31, and CK/18; hepar-1 was focally positive; TTF-1, CK20, and GCDFP-15 were negative.

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