Dillon P, Fanous I. Pancreatic adenocarcinoma with atypical metastases to the brainstem. J Case Rep Images Oncology 2016;2:42–46.
Pancreatic adenocarcinoma is the most common exocrine pancreatic cancer and has a five-year survival rate of 5–7%. Adenocarcinomas of the pancreas most commonly spread to the liver, followed by lung and bone metastases. Central nervous system involvement is exceedingly rare and has been reported to be less than 1%.
We report the first case of pancreatic adenocarcinoma metastatic to the brainstem and review predisposing factors and treatment options. The patient we describe was a 63-year-old found to have stage IIb pancreatic cancer. He underwent an uncomplicated pancreaticoduodenectomy followed by standard chemoradiation then adjuvant 5FU and gemcitabine chemotherapy along with a vaccine therapy. After two years, the patient had isolated recurrences in lung and adrenal gland with excellent responses to ablative therapies. He ultimately developed brain stem metastases after five years and these were treated with Gamma Knife therapy and bevacizumab.
Brain metastases from pancreatic cancer have a very poor prognosis. Surgery, radiosurgery, and whole brain radiation are standard treatments. Anti-VEGF therapy may have some activity as well. It is postulated that increasingly longer survival times in pancreatic cancer patients may uncover rare sites of disease such as the brainstem. Immunotherapy in this case may have contributed to prolonged survival and may or may not have a role in control of disease in sanctuary sites such as the brain.
Patrick Dillon – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ibrahim Fanous – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
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Authors declare no conflict of interest.