Table of Contents    
Case Report
Pancreatic adenocarcinoma with atypical metastases to the brainstem
Patrick Dillon1, Ibrahim Fanous1
1MD, University of Virginia.

Article ID: 100020Z10PD2016

Address correspondence to:
Patrick Dillon
MD, Assistant Professor, Division of Hematology/Oncology
University of Virginia, Box 800716
Charlottesville, VA 22908
United States

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How to cite this article:
Dillon P, Fanous I. Pancreatic adenocarcinoma with atypical metastases to the brainstem. J Case Rep Images Oncology 2016;2:42–46.

Introduction: 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%.
Case Report: 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.
Conclusion: 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.

Keywords: Adenocarcinoma, Brainstem, Metastasis, Pancreas

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Author Contributions
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
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
Conflict of interest
Authors declare no conflict of interest.
© 2016 Patrick Dillon et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.