Initial Cutaneous Metastases of Pancreatic Cancer without Evidence of Pancreatic Mass

[摘要] Background: Pancreatic cancer has high malignant potential and has one of the worst prognosis. Local symptoms are not well defined in pancreatic cancer because it is located in the retroperitoneum and has a thin film. Patients often do not present with the early stages of the disease. Immunohistochemical screening methods assist in diagnosing the primary tumor of origin. Case Report: A 76-year-old male presented with 1-year post laparoscopic para-esophageal hernia repair. He presented with intermittent discharge and nodular thickening around the anterior abdominal wall post-surgery with CT-guided biopsy showing metastatic adenocarcinoma, a PET/CT scan showing no abnormality within the pancreas, CA19-9 elevated, and immunostains suggestive of pancreaticobiliary primary. The patient was treated with FOLFIRINOX chemotherapy, which is the first-line treatment for metastatic pancreatic cancer, and he had an excellent response within just two cycles. Conclusion: Cutaneous metastases of pancreatic cancer without any evidence of pancreatic mass is an unusual presentation. Hence full workup including biopsy, immunohistochemical stains, PET/CT scan, serum tumor markers, and additional gastrointestinal workup (EUS, ERCP) is required to evaluate for primary pancreatic mass.

[学科分类] 生理学

[关键词] Adenocarcinoma;Biopsy;CA-19-9 Antigen;Fluorouracil;Pancreatic Neoplasms.