A Resected Case of Carcinoma of the Pancreatic Tail with Distant Colon Metastasis

Tatsuto Ashizawa, Keiichirou Yamamoto, Kenji Katsumata, Tetsuo Sumi, Kazuhiro Nagashima, Takashi Murohashi, Yuuki Nakamura¹⁾, Makoto Mochizuki²⁾, Tatsuya Aoki and Yasuhisa Koyanagi³⁾

Department of Digestive Tract Surgery¹⁾, Department of Pathology²⁾,
Hachioji Medical Center of Tokyo Medical University,
Department of Surgery, Tokyo Medical University³⁾

We report an extremely rare case of carcinoma of the pancreatic tail with distant colon metastasis. A 75-year old man complaining of abdominal pain was admitted because of ileus. Obstruction and stenosis of the descending colon were recognized by barium-enema and colonoscopy. An ill-defined tumor adjacent to the pancreatic tail was detected in the retroperitoneum by CT scan. Pancreatic carcinoma involving the splenic flexure of the colon was diagnosed preoperatively. During the operation, we recognized another tumor on the anal side of the descending colon. We therefore performed distal pancreatectomy, splenectomy, left-adrenalectomy and left-hemicolectomy. In the resected material, an ill-defined retroperitoneal tumor mass, which was a histopathologically well-differentiated adenocarcinoma, was found. Tumor invasion was observed in the pancreatic tail, colon and left-adrenal gland. We considered the tumor to be pancreatic in origin because columnar tumor cells grew along the pancreatic duct and the colonial mucosal lesion was intact, while the other colon tumor was considered to be metastatic from the pancreatic carcinoma because it was shown histopathologically to mainly occupy the submucosal and muscularis propria layers and to be a well-differentiated adenocarcinoma, as was the primary tumor. There was no evidence of continuous invasion from the primary tumor, nor was there lymph node metastasis or peritoneal dissemination. Thus, hematogenous metastasis was strongly suspected.

Key words
pancreatic carcinoma, secondary colon carcinoma, hematogenous metastasis

Reprint requests
Tatsuto Ashizawa Department of Digestive Tract Surgery, Hachioji Medical Center of Tokyo Medical University 1163 Tate-machi, Hachioji-shi, Tokyo, 193-0998 JAPAN

Accepted
May 23, 2000

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