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Published in: World Journal of Surgical Oncology 1/2012

Open Access 01-12-2012 | Case report

Oncocytic-type intraductal papillary mucinous neoplasm (IPMN)-derived invasive oncocytic pancreatic carcinoma with brain metastasis - a case report

Authors: Kun-Chun Chiang, Chi-Chang Yu, Jim-Ray Chen, Yu-Ting Huang, Cheng-Cheng Huang, Chun-Nan Yeh, Chien-Sheng Tsai, Li-Wei Chen, Hsien-Cin Chen, Jun-Te Hsu, Cheng-Hsu Wang, Huang-Yang Chen

Published in: World Journal of Surgical Oncology | Issue 1/2012

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Abstract

Pancreatic cancer is a lethal disease without effective treatments at present. It ranks as s as 4th and 5th in cancer-related mortality in the western countries and worldwide. Locally advanced pancreatic duct carcinoma (PDAC) and metastatic PDAC, usually found the metastases over liver, peritoneum, or lung, have been shown to be with dismal prognosis. Brain metastasis is a rare entity and most cases reported before were found post-mortem. Intraductal papillary mucinous neoplasms of the pancreas (IPMN) has been deemed as a precursor of PDAC with very slow progression rate. Here we reported a case diagnosed with IPMN-derived PDAC with brain metastasis. After surgeries for PDAC and brain metastasis, subsequent chemotherapy and radiotherapy were also given. One and half year after surgery, this patient is still living with good performance status, which may warrant individualization of therapeutic strategy for PDAC with only brain metastasis.
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Literature
1.
go back to reference Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin. 2011, 61: 69-90. 10.3322/caac.20107.CrossRefPubMed Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin. 2011, 61: 69-90. 10.3322/caac.20107.CrossRefPubMed
2.
go back to reference Hruban RH, Pitman MB, Klimstra DS: Tumors of the Pancreas. Atlas of Tumor Pathology, 4th series, fascicle 6. Washington: Proceedings of the American Registry of Pathology. 2007 Hruban RH, Pitman MB, Klimstra DS: Tumors of the Pancreas. Atlas of Tumor Pathology, 4th series, fascicle 6. Washington: Proceedings of the American Registry of Pathology. 2007
3.
go back to reference Grutzmann R, Niedergethmann M, Pilarsky C, Kloppel G, Saeger HD: Intraductal papillary mucinous tumors of the pancreas: biology, diagnosis, and treatment. Oncologist. 2010, 15: 1294-1309. 10.1634/theoncologist.2010-0151. 10.1634/theoncologist.2010-0151PubMedCentralCrossRefPubMed Grutzmann R, Niedergethmann M, Pilarsky C, Kloppel G, Saeger HD: Intraductal papillary mucinous tumors of the pancreas: biology, diagnosis, and treatment. Oncologist. 2010, 15: 1294-1309. 10.1634/theoncologist.2010-0151. 10.1634/theoncologist.2010-0151PubMedCentralCrossRefPubMed
4.
go back to reference Ohhashi K, Murakami Y, Maruyama M, Takekoshi T, Ohta H, Ohhashi I: Four cases of mucous secreting pancreatic cancer. Prog Dig Endosc. 1982, 20: 348-351. Ohhashi K, Murakami Y, Maruyama M, Takekoshi T, Ohta H, Ohhashi I: Four cases of mucous secreting pancreatic cancer. Prog Dig Endosc. 1982, 20: 348-351.
5.
go back to reference Brugge WR, Lauwers GY, Sahani D, Fernandez-del Castillo C, Warshaw AL: Cystic neoplasms of the pancreas. N Engl J Med. 2004, 351: 1218-1226. 10.1056/NEJMra031623. 10.1056/NEJMra031623 351/12/1218CrossRefPubMed Brugge WR, Lauwers GY, Sahani D, Fernandez-del Castillo C, Warshaw AL: Cystic neoplasms of the pancreas. N Engl J Med. 2004, 351: 1218-1226. 10.1056/NEJMra031623. 10.1056/NEJMra031623 351/12/1218CrossRefPubMed
6.
go back to reference Belyaev O, Seelig MH, Muller CA, Tannapfel A, Schmidt WE, Uhl W: Intraductal papillary mucinous neoplasms of the pancreas. J Clin Gastroenterol. 2008, 42: 284-294. 10.1097/MCG.0b013e3180500761PubMed Belyaev O, Seelig MH, Muller CA, Tannapfel A, Schmidt WE, Uhl W: Intraductal papillary mucinous neoplasms of the pancreas. J Clin Gastroenterol. 2008, 42: 284-294. 10.1097/MCG.0b013e3180500761PubMed
7.
go back to reference Kloppel GES, Solcia E, Longnecker DS, Capella C, Sobin LH: World Health Organization. Institutional Histological Classification of Tumors. Histological Typing of Tumors of the Exocrine Pancreas. 1996, Berlin: Springer-VerlagCrossRef Kloppel GES, Solcia E, Longnecker DS, Capella C, Sobin LH: World Health Organization. Institutional Histological Classification of Tumors. Histological Typing of Tumors of the Exocrine Pancreas. 1996, Berlin: Springer-VerlagCrossRef
8.
go back to reference Obara T, Maguchi H, Saitoh Y, Itoh A, Arisato S, Ashida T, Nishino N, Ura H, Namiki M: Mucin-producing tumor of the pancreas: natural history and serial pancreatogram changes. Am J Gastroenterol. 1993, 88: 564-569.PubMed Obara T, Maguchi H, Saitoh Y, Itoh A, Arisato S, Ashida T, Nishino N, Ura H, Namiki M: Mucin-producing tumor of the pancreas: natural history and serial pancreatogram changes. Am J Gastroenterol. 1993, 88: 564-569.PubMed
9.
go back to reference Levy P, Jouannaud V, O'Toole D, Couvelard A, Vullierme MP, Palazzo L, Aubert A, Ponsot P, Sauvanet A, Maire F, Hentic O, Hammel P, Ruszniewski P: Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol. 2006, 4: 460-468. 10.1016/j.cgh.2006.01.018. 10.1016/j.cgh.2006.01.018]CrossRefPubMed Levy P, Jouannaud V, O'Toole D, Couvelard A, Vullierme MP, Palazzo L, Aubert A, Ponsot P, Sauvanet A, Maire F, Hentic O, Hammel P, Ruszniewski P: Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol. 2006, 4: 460-468. 10.1016/j.cgh.2006.01.018. 10.1016/j.cgh.2006.01.018]CrossRefPubMed
10.
go back to reference Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA, Lillemoe KD: Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004, 239: 788-797. 10.1097/01.sla.0000128306.90650.aa. discussion 797-789PubMedCentralCrossRefPubMed Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA, Lillemoe KD: Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004, 239: 788-797. 10.1097/01.sla.0000128306.90650.aa. discussion 797-789PubMedCentralCrossRefPubMed
11.
go back to reference D'Angelica M, Brennan MF, Suriawinata AA, Klimstra D, Conlon KC: Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg. 2004, 239: 400-408. 10.1097/01.sla.0000114132.47816.dd.PubMedCentralCrossRefPubMed D'Angelica M, Brennan MF, Suriawinata AA, Klimstra D, Conlon KC: Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg. 2004, 239: 400-408. 10.1097/01.sla.0000114132.47816.dd.PubMedCentralCrossRefPubMed
12.
go back to reference Raut CP, Cleary KR, Staerkel GA, Abbruzzese JL, Wolff RA, Lee JH, Vauthey JN, Lee JE, Pisters PW, Evans DB: Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol. 2006, 13: 582-594. 10.1245/ASO.2006.05.002. 10.1245/ASO.2006.05.002CrossRefPubMed Raut CP, Cleary KR, Staerkel GA, Abbruzzese JL, Wolff RA, Lee JH, Vauthey JN, Lee JE, Pisters PW, Evans DB: Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol. 2006, 13: 582-594. 10.1245/ASO.2006.05.002. 10.1245/ASO.2006.05.002CrossRefPubMed
13.
go back to reference Z'Graggen K, Rivera JA, Compton CC, Pins M, Werner J: Fernandez-del Castillo C, Rattner DW, Lewandrowski KB, Rustgi AK, Warshaw AL: Prevalence of activating K-ras mutations in the evolutionary stages of neoplasia in intraductal papillary mucinous tumors of the pancreas. Ann Surg. 1997, 226: 491-498. 10.1097/00000658-199710000-00010. discussion 498–500PubMedCentralCrossRefPubMed Z'Graggen K, Rivera JA, Compton CC, Pins M, Werner J: Fernandez-del Castillo C, Rattner DW, Lewandrowski KB, Rustgi AK, Warshaw AL: Prevalence of activating K-ras mutations in the evolutionary stages of neoplasia in intraductal papillary mucinous tumors of the pancreas. Ann Surg. 1997, 226: 491-498. 10.1097/00000658-199710000-00010. discussion 498–500PubMedCentralCrossRefPubMed
14.
go back to reference Salvia R, Fernandez-del Castillo C, Bassi C, Thayer SP, Falconi M, Mantovani W, Pederzoli P, Warshaw AL: Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004, 239: 678-685. 10.1097/01.sla.0000124386.54496.15. discussion 685-677PubMedCentralCrossRefPubMed Salvia R, Fernandez-del Castillo C, Bassi C, Thayer SP, Falconi M, Mantovani W, Pederzoli P, Warshaw AL: Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004, 239: 678-685. 10.1097/01.sla.0000124386.54496.15. discussion 685-677PubMedCentralCrossRefPubMed
15.
go back to reference Mino-Kenudson M, Fernandez-Del Castillo C, Baba Y, Valsangkar NP, Liss AS, Hsu M, Correa-Gallego C, Ingkakul T, Johnston RP, Turner BG, Androutsopoulos V, Deshpande V, McGrath D, Sahani DV, Brugge WR, Ogino S, Pitman MB, Warshaw AL, Thayer SP: Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut. 2011, 60: 1712-1720. 10.1136/gut.2010.232272. 10.1136/gut.2010.232272PubMedCentralCrossRefPubMed Mino-Kenudson M, Fernandez-Del Castillo C, Baba Y, Valsangkar NP, Liss AS, Hsu M, Correa-Gallego C, Ingkakul T, Johnston RP, Turner BG, Androutsopoulos V, Deshpande V, McGrath D, Sahani DV, Brugge WR, Ogino S, Pitman MB, Warshaw AL, Thayer SP: Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut. 2011, 60: 1712-1720. 10.1136/gut.2010.232272. 10.1136/gut.2010.232272PubMedCentralCrossRefPubMed
16.
go back to reference Shimada K, Sakamoto Y, Sano T, Kosuge T, Hiraoka N: Invasive carcinoma originating in an intraductal papillary mucinous neoplasm of the pancreas: a clinicopathologic comparison with a common type of invasive ductal carcinoma. Pancreas. 2006, 32: 281-287. 10.1097/01.mpa.0000202955.33483.e2. 10.1097/01.mpa.0000202955.33483CrossRefPubMed Shimada K, Sakamoto Y, Sano T, Kosuge T, Hiraoka N: Invasive carcinoma originating in an intraductal papillary mucinous neoplasm of the pancreas: a clinicopathologic comparison with a common type of invasive ductal carcinoma. Pancreas. 2006, 32: 281-287. 10.1097/01.mpa.0000202955.33483.e2. 10.1097/01.mpa.0000202955.33483CrossRefPubMed
17.
go back to reference Maire F, Hammel P, Terris B, Paye F, Scoazec JY, Cellier C, Barthet M, O'Toole D, Rufat P, Partensky C, Cuillerier E, Levy P, Belghiti J, Ruszniewski P: Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma. Gut. 2002, 51: 717-722. 10.1136/gut.51.5.717.PubMedCentralCrossRefPubMed Maire F, Hammel P, Terris B, Paye F, Scoazec JY, Cellier C, Barthet M, O'Toole D, Rufat P, Partensky C, Cuillerier E, Levy P, Belghiti J, Ruszniewski P: Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma. Gut. 2002, 51: 717-722. 10.1136/gut.51.5.717.PubMedCentralCrossRefPubMed
18.
go back to reference Yopp AC, Katabi N, Janakos M, Klimstra DS, D'Angelica MI, DeMatteo RP, Fong Y, Brennan MF, Jarnagin WR, Allen PJ: Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas: a matched control study with conventional pancreatic ductal adenocarcinoma. Ann Surg. 2011, 253: 968-974. 10.1097/SLA.0b013e318214bcb4. 10.1097/SLA.0b013e318214bcb4CrossRefPubMed Yopp AC, Katabi N, Janakos M, Klimstra DS, D'Angelica MI, DeMatteo RP, Fong Y, Brennan MF, Jarnagin WR, Allen PJ: Invasive carcinoma arising in intraductal papillary mucinous neoplasms of the pancreas: a matched control study with conventional pancreatic ductal adenocarcinoma. Ann Surg. 2011, 253: 968-974. 10.1097/SLA.0b013e318214bcb4. 10.1097/SLA.0b013e318214bcb4CrossRefPubMed
19.
go back to reference Hidalgo M: Pancreatic cancer. N Engl J Med. 2010, 362: 1605-1617. 10.1056/NEJMra0901557. 10.1056/NEJMra0901557CrossRefPubMed Hidalgo M: Pancreatic cancer. N Engl J Med. 2010, 362: 1605-1617. 10.1056/NEJMra0901557. 10.1056/NEJMra0901557CrossRefPubMed
20.
go back to reference Lee YT, Tatter D: Carcinoma of the pancreas and periampullary structures, Pattern of metastasis at autopsy. Arch Pathol Lab Med. 1984, 108: 584-587.PubMed Lee YT, Tatter D: Carcinoma of the pancreas and periampullary structures, Pattern of metastasis at autopsy. Arch Pathol Lab Med. 1984, 108: 584-587.PubMed
21.
go back to reference Shangai VA, Gavrik Iu V: Metastasis of pancreatic cancer to the brain. Vrach Delo. 1984, 11: 77-79.PubMed Shangai VA, Gavrik Iu V: Metastasis of pancreatic cancer to the brain. Vrach Delo. 1984, 11: 77-79.PubMed
22.
go back to reference Olson ME, Chernik NL, Posner JB: Infiltration of the leptomeninges by systemic cancer, A clinical and pathologic study. Arch Neurol. 1974, 30: 122-137. 10.1001/archneur.1974.00490320010002.CrossRefPubMed Olson ME, Chernik NL, Posner JB: Infiltration of the leptomeninges by systemic cancer, A clinical and pathologic study. Arch Neurol. 1974, 30: 122-137. 10.1001/archneur.1974.00490320010002.CrossRefPubMed
23.
go back to reference Caricato M, Borzomati D, Ausania F, Garberini A, Rabitti C, Tonini G, Coppola R: Cerebellar metastasis from pancreatic adenocarcinoma. A case report. Pancreatology. 2006, 6: 306-308. 10.1159/000092693. 10.1159/000092693CrossRefPubMed Caricato M, Borzomati D, Ausania F, Garberini A, Rabitti C, Tonini G, Coppola R: Cerebellar metastasis from pancreatic adenocarcinoma. A case report. Pancreatology. 2006, 6: 306-308. 10.1159/000092693. 10.1159/000092693CrossRefPubMed
24.
go back to reference Renouf D, Moore M: Evolution of systemic therapy for advanced pancreatic cancer. Expert Rev Anticancer Ther. 2010, 10: 529-540. 10.1586/era.10.21. 10.1586/era.10.21CrossRefPubMed Renouf D, Moore M: Evolution of systemic therapy for advanced pancreatic cancer. Expert Rev Anticancer Ther. 2010, 10: 529-540. 10.1586/era.10.21. 10.1586/era.10.21CrossRefPubMed
25.
go back to reference Vazquez BJ, Richards ML, Lohse CM, Thompson GB, Farley DR, Grant CS, Huebner M, Moreno J: Adrenalectomy improves outcomes of selected patients with metastatic carcinoma. World J Surg. 2012, 36: 1400-1405. 10.1007/s00268-012-1506-3.CrossRefPubMed Vazquez BJ, Richards ML, Lohse CM, Thompson GB, Farley DR, Grant CS, Huebner M, Moreno J: Adrenalectomy improves outcomes of selected patients with metastatic carcinoma. World J Surg. 2012, 36: 1400-1405. 10.1007/s00268-012-1506-3.CrossRefPubMed
26.
go back to reference Huguet F, Andre T, Hammel P, Artru P, Balosso J, Selle F, Deniaud-Alexandre E, Ruszniewski P, Touboul E, Labianca R, de Gramont A, Louvet C: Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol. 2007, 25: 326-331. 10.1200/JCO.2006.07.5663. 10.1200/JCO.2006.07.5663CrossRefPubMed Huguet F, Andre T, Hammel P, Artru P, Balosso J, Selle F, Deniaud-Alexandre E, Ruszniewski P, Touboul E, Labianca R, de Gramont A, Louvet C: Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol. 2007, 25: 326-331. 10.1200/JCO.2006.07.5663. 10.1200/JCO.2006.07.5663CrossRefPubMed
27.
go back to reference Sultana A, Tudur Smith C, Cunningham D, Starling N, Tait D, Neoptolemos JP, Ghaneh P: Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy. Br J Cancer. 2007, 96: 1183-1190. 10.1038/sj.bjc.6603719. 10.1038/sj.bjc.6603719PubMedCentralCrossRefPubMed Sultana A, Tudur Smith C, Cunningham D, Starling N, Tait D, Neoptolemos JP, Ghaneh P: Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy. Br J Cancer. 2007, 96: 1183-1190. 10.1038/sj.bjc.6603719. 10.1038/sj.bjc.6603719PubMedCentralCrossRefPubMed
28.
go back to reference Carter SK, Comis RL: The integration of chemotherapy into a combined modality approach for cancer treatment. VI. Pancreatic adenocarcinoma. Cancer Treat Rev. 1975, 2: 193-214. 10.1016/S0305-7372(75)80003-X.CrossRefPubMed Carter SK, Comis RL: The integration of chemotherapy into a combined modality approach for cancer treatment. VI. Pancreatic adenocarcinoma. Cancer Treat Rev. 1975, 2: 193-214. 10.1016/S0305-7372(75)80003-X.CrossRefPubMed
29.
go back to reference Cullinan S, Moertel CG, Wieand HS, Schutt AJ, Krook JE, Foley JF, Norris BD, Kardinal CG, Tschetter LK, Barlow JF: A phase III trial on the therapy of advanced pancreatic carcinoma. Evaluations of the Mallinson regimen and combined 5-fluorouracil, doxorubicin, and cisplatin. Cancer. 1990, 65: 2207-2212. 10.1002/1097-0142(19900515)65:10<2207::AID-CNCR2820651007>3.0.CO;2-Y.CrossRefPubMed Cullinan S, Moertel CG, Wieand HS, Schutt AJ, Krook JE, Foley JF, Norris BD, Kardinal CG, Tschetter LK, Barlow JF: A phase III trial on the therapy of advanced pancreatic carcinoma. Evaluations of the Mallinson regimen and combined 5-fluorouracil, doxorubicin, and cisplatin. Cancer. 1990, 65: 2207-2212. 10.1002/1097-0142(19900515)65:10<2207::AID-CNCR2820651007>3.0.CO;2-Y.CrossRefPubMed
Metadata
Title
Oncocytic-type intraductal papillary mucinous neoplasm (IPMN)-derived invasive oncocytic pancreatic carcinoma with brain metastasis - a case report
Authors
Kun-Chun Chiang
Chi-Chang Yu
Jim-Ray Chen
Yu-Ting Huang
Cheng-Cheng Huang
Chun-Nan Yeh
Chien-Sheng Tsai
Li-Wei Chen
Hsien-Cin Chen
Jun-Te Hsu
Cheng-Hsu Wang
Huang-Yang Chen
Publication date
01-12-2012
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2012
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-10-138

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