2024, Number 5
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Rev Fac Med UNAM 2024; 67 (5)
Multiple Brain Metastases from Pancreatic Adenocarcinoma: A Case Report
Alonso BSA, Arroyo ZOJ, Laredo GJ, Vázquez NJR
Language: Spanish
References: 15
Page: 42-49
PDF size: 401.42 Kb.
ABSTRACT
Introduction: Brain metastases are the most common malignant
lesions in the central nervous system. Brain metastases
from pancreatic cancer are very rare, with poor prognosis.
The present paper aims to describe a rare pathology and the
work carried out for the patient's care.
Case report: 49-year-old man with personality changes, depression,
and apathy. Five days before admission, he presented
dysarthria, added left hemiparesis, and disorientation
that progressed to sudden neurological deterioration
that required advanced airway management. A computed
tomography study was seen with cerebral cystic lesions. A
decompressive craniectomy and drainage of the larger lesion
was performed, with subsequent resection. The study protocol
with immunohistochemistry reports CK 19, compatible
with pancreatic adenocarcinoma.
Conclusions: A rare case of multiple brain metastases and
suspected lung metastasis, both secondary to primary pancreatic
adenocarcinoma was presented. The patient began
with symptoms associated with brain lesions. The incidence
of brain metastases with a primary pancreatic tumor is very
low, and this is an exceptional case when presenting with neurological
symptoms. Surgical resection of the brain lesion had
a limited role in the clinical improvement of the patient since
the progression of the disease was rapid. Still, it was useful to
establish a diagnosis by immunohistochemistry. Since there are
no screening tests for pancreatic tumors, it is difficult to identify
them in early stages and without gastrointestinal symptoms.
REFERENCES
Kotecha R, Gondi V, Ahluwalia MS, Brastianos PK, MehtaMP. Recent advances in managing brain metastasis.F1000Research. 2018;7(Faculty Rev):1772. doi: 10.12688/f1000research.15903.1
Noh T, Walbert T. Brain metastasis: clinical manifestations,symptom management, and palliative care. HandbClin Neurol. 2018;149:75-88. doi: 10.1016/B978-0-12-811161-1.00006-2
Matsuo S, Amano T, Kawauchi S, Nakamizo A. Multiplebrain metastases from pancreatic adenocarcinomamanifesting with simultaneous intratumoral hemorrhages.World Neurosurg. 2019;123:221-5. doi: 10.1016/j.wneu.2018.12.036
Esmaeilzadeh M, Majlesara A, Faridar A, Hafezi M, HongB, Esmaeilnia-Shirvani H, et al. Brain metastasis fromgastrointestinal cancers: a systematic review. Int J ClinPract. 2014;68(7):890-9. doi: 10.1111/ijcp.12395
Sasaki T, Sato T, Nakai Y, Sasahira N, Isayama H, KoikeK. Brain metastasis in pancreatic cancer: Two case reports.Medicine (Baltimore). 2019;98(4):e14227. doi: 10.1097/MD.0000000000014227
Cherri S, Noventa S, Zaniboni A. Pancreatic adenocarcinoma:Beyond first line, where are we? World J Gastroenterol.2021;27(17):1847-63. doi: 10.3748/wjg.v27.i17.1847
Vareedayah AA, Alkaade S, Taylor JR. Pancreatic adenocarcinoma.Mo Med. 2018;115(3):230-5.
Park W, Chawla A, O’Reilly EM. Pancreatic cancer: A review.JAMA. 2021;326(9):851-62. doi: 10.1001/jama.2021.13027
He C, Huang X, Zhang Y, Lin X, Li S. The impact ofdifferent metastatic patterns on survival in patients withpancreatic cancer. Pancreatology. 2021;21(3):556-63. doi:
10.1016/j.pan.2021.01.01410. Oka Y, Takano S, Kouchi Y, Furukawa K, Takayashiki T,Kuboki S, et al. Simultaneous brain and lung metastasesof pancreatic ductal adenocarcinoma after curative pancreatectomy:a case report and literature review. BMC Gastroenterol.2021;21(1):9. doi: 10.1186/s12876-020-01587-3
Papadimitriou K, Kiss-Bodolay D, Hedjoudje A, MillanDS, Simonin A, Fournier JY, et al. Late metachronouscerebral metastasis of pancreatic adenocarcinoma ofthe tail of the pancreas: a case report. J Med Case Rep.2022;16(1):144. doi: 10.1186/s13256-022-03314-w
Singhi AD, Koay EJ, Chari ST, Maitra A. Early detectionof pancreatic cancer: opportunities and challenges.Gastroenterology. 2019;156(7):2024-40. doi: 10.1053/j.gastro.2019.01.259
Mehrpouya M, Pourhashem Z, Yardehnavi N, OladnabiM. Evaluation of cytokeratin 19 as a prognostic tumoraland metastatic marker with focus on improved detectionmethods. J Cell Physiol. 2019;234(12):21425-35. doi:10.1002/jcp.28768
Menz A, Bauer R, Kluth M, von Bargen CM, GorbokonN, Viehweger F, et al. Diagnostic and prognostic impactof cytokeratin 19 expression analysis in human tumors: atissue microarray study of 13,172 tumors. Hum Pathol.2021;115:19-36. doi: 10.1016/j.humpath.2021.05.012
Jain R, Fischer S, Serra S, Chetty R. The use of Cytokeratin19 (CK19) immunohistochemistry in lesions of thepancreas, gastrointestinal tract, and liver. Appl ImmunohistochemMol Morphol. 2010;18(1):9-15. doi: 10.1097/PAI.0b013e3181ad36ea