Pancreatic ampullary carcinoma with neck metastases: a case report
© Aksoy et al; licensee BioMed Central Ltd. 2009
Received: 19 September 2009
Accepted: 1 October 2009
Published: 1 October 2009
An 18-year-old Turkish woman was referred with a 6-week history of rapidly enlarging cervical mass at the left side.
She was diagnosed of ampullary carcinoma for which pancreatoduodenectomy was performed 14 months ago. In our patient with a history of malignancy, a rapidly enlarging neck mass was considered a metastasis to the neck. Tumor resection was performed. Histopathological examination revealed the metastasis of the precedent ampullary adenocarcinoma.
Surgery does not improve survival for advanced metastatic ampullary cancer however, it can be mandatory in specific conditions as our patient.
Periampullary neoplasms include carcinomas of the duodenum, ampulla of Vater, distal common bile duct and pancreas. They are considered collectively because of their similar clinical presentation and the difficulty in distinguishing them without examination of a resected specimen [1, 2]. More than one half of cases have distant metastasis at diagnosis. Most frequent sites of metastasis are local lymph nodes, lung, liver, adrenal glands, kidney and bones [3–7]. To our knowledge, this is the rare report of a ampullary cancer with neck metastasis.
An 18-year-old Turkish woman was referred from Oncology Department with a 6-week history of rapidly enlarging cervical mass at the left side of her neck which had been detected by the patient herself. She was diagnosed of ampullary carcinoma for which pancreatoduodenectomy was performed 14 months ago. Histopathological examination revealed well-differentiated adenocarcinoma in the ampullary region. Only one lymph node metastasis was present among 35 dissected lymph nodes. Additionaly, peripancreatic fat tissue invasion was also remarked. She has not a family history of pancreas cancer. Gemcitabine was started 1000 mg/m2 Day 1,8,15/every 28 days for ampullary cancer. After chemotherapy performed, she lost follow-up.
In our patient with a history of malignancy, a rapidly enlarging neck mass was considered a metastasis to the neck. Since imaging studies suggested malignant tumor, a Tru-cut biopsy was performed. Cytologic findings did not provide any further information. After Tru-cut biopsy, severe compressive symptoms and stridor were occured. Those symptoms, accompanied by the enlargement of the mass, were suggestive of intralesional bleeding following biopsy (Figure 1B).
Overall, periampullary cancers account for 5% of all gastrointestinal tract malignancies, which can be divided into four groups of tumor entities: periampullary adenocarcinoma originates from the pancreatic duct (pancreatic carcinoma), the mucosa of the ampulla of Vater (ampullary carcinoma), the common distal bile duct segment (distal cholangiocellular carcinoma) or the duodenum (duodenal adenocarcinoma) [1, 2].
Panreatic cancer occurs most frequently among the periampullary cancers, accounting for 3% of all gastrointestinal cancers. Carcinoma of the ampulla of Vateri is the second most common periampullary malignancy. Less frequent are distal cholangiocellular carcinoma and duodenal adenocarcinoma of the periampullary region (1). The prognosis of a 5-year survival rate between 1% and 10% for all periampullary cancers still remains a frustrating challenge. However, it has been shown that periampullary tumors, not arising from the pancreatic duct, have a much beter outcome .
Morbidity and mortality from pancreatic cancer is conspicuously associated with metastasis; the most frequent sites of metastasis are local lymph nodes, lung, liver, adrenal glands, kidney and bones. Patients with pancreatic cancer have only very rarely been reported to develop metastatic lesions to the brain, skin, and larynx (3-7). Cervical lymph node and brain metastases from pancreatic cancer have rarely been seen and most of them were identified in advanced stage [5, 8]. In our case, histopathologic examination did not reveal any lymphoid tissue, which suggests a soft tissue metastasis to the neck. However, it is not possible to prove this hypothesis. Despite the fact that our patient was in an advanced stage, the excision was performed to prevent respiratory difficulties.
While surgery does not improve survival for advanced metastatic ampullary cancer, it can be mandatory in specific conditions as our patient.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- Berberat PO, Künzli BM, Gulbinas A, Ramanauskas T, Kleeff J, Müller MW, Wagner M, Friess H, Büchler MW: An audit of outcomes of a series of periampullary carcinomas. Eur J Surg Oncol. 2009, 35: 187-91.View ArticlePubMedGoogle Scholar
- Diener MK, Knaebel HP, Heukaufer C, Antes G, Büchler MW, Seiler CM: A systematic review and meta-analysis of pylorus-preserving versus classical pancreaticoduodenectomy for surgical treatment of periampullary and pancreatic carcinoma. Ann Surg. 2007, 245: 187-200. 10.1097/01.sla.0000242711.74502.a9.PubMed CentralView ArticlePubMedGoogle Scholar
- Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, Wingo PA, Jemal A, Feigal EG: Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. Cancer. 2002, 94: 2766-92. 10.1002/cncr.10593.View ArticlePubMedGoogle Scholar
- Yendluri V, Centeno B, Springett GM: Pancreatic cancer presenting as a Sister Mary Joseph's nodule: case report and update of the literature. Pancreas. 2007, 34: 161-4. 10.1097/01.mpa.0000240602.18688.43.View ArticlePubMedGoogle Scholar
- 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: 306-8. 10.1159/000092693.View ArticlePubMedGoogle Scholar
- Hafez H: Cutaneous pancreatic metastasis: A case report and review of literature. Indian J Cancer. 2007, 44: 111-4. 10.4103/0019-509X.38943.View ArticlePubMedGoogle Scholar
- Oku T, Hasegawa M, Watanabe I, Nasu M, Aoki N: Pancreatic cancer with metastasis to the larynx. J Laryngol Otol. 1980, 94: 1205-9. 10.1017/S0022215100090010.View ArticlePubMedGoogle Scholar
- Funakoshi A, Senju T, Sumii T: Two cases of advanced pancreatic cancer with cervical lymph node or liver metastasis responding well to S-1 monotherapy. Gan To Kagaku Ryoho. 2006, 33: 1505-9.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.