Primary pancreatic neoplasia or metastasis from colon carcinoma?

The pancreas is an unusual but occasionally favored target for metastasis from other primary cancers. Metastases have been described for various non-hematologic neoplasms, such as renal-cell carcinoma, pulmonary small-cell carcinoma, melanoma and gastric carcinoma.

We report the case of a 77-year old man with a mass in the pancreatic head five years after anterior resection for adenocarcinoma of the colon and three years after resection of a lung metastasis. The patient underwent pylorus-preserving pancreaticoduodenectomy (Longmire-Traverso) and lymph-node dissection of compartment II.

It is rare to have solitary metastases to the pancreas which clinically may mimic a primary neoplasm of the pancreas. Clinical features, as well as MRI and PET findings in patients with pancreatic metastasis from colon carcinoma are similar to those of primary pancreatic ductal adenocarcinoma. The diagnosis of metastasis should be considered when patients have a pancreatic mass and a history of non-pancreatic malignant lesions. Radical resection may prolong survival in patients if the pancreas is the only locus for metastasis at the time of diagnosis.