Ann Hepatobiliary Pancreat Surg.  2021 Aug;25(3):440-444. 10.14701/ahbps.2021.25.3.440.

Curative resection of bladder cancer with pancreas head metastasis

• Park YM
• Seo HI
• Hong SB
• Kim S
• Kim TN
• Lee SJ

• KMID: 2519306
• DOI: http://doi.org/10.14701/ahbps.2021.25.3.440

Abstract

Bladder cancer is the 9th most frequent cancer worldwide. Its incidence is increasing. The pancreas is an infrequent site of metastasis in relation to any type of malignancy. In this study, we report our experience with a patient who has undergone a pancreaticoduodenectomy for metastatic bladder cancer. A 61-year-old male was admitted with jaundice and pancreas head mass. He underwent robot assisted-cystectomy and ileal conduit for bladder cancer 7 months ago. Initial diagnosis under the imaging study was a resectable pancreas head cancer. However, we did not rule-out a metastatic bladder cancer. He underwent a classic pancreaticoduodenectomy. Based on histologic findings and immunohistochemistry results, a pancreas tumor with 4.9-cm sized metastatic urothelial carcinoma was diagnosed. He experienced no complication. He was discharged 11 days after the surgery. Four cycles of gemcitabine and cisplatin were administered. He remained recurrence-free of tumors for 16 months. Although the benefit of pancreatectomy for patient survival has been reported for metastases from renal cell carcinoma, it is unknown for bladder cancer because of no report. We believe that curative resection for metastasis to pancreas of urothelial carcinoma might be helpful for its management.

Keyword

Uurinary bladder neoplasm; Neoplasm metastasis; Pancreaticoduodenectomy; Pancreatic neoplasm

Figure

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  Fig. 1 (A, B) Contrast enhanced computed tomography images demonstrating a 3.6-cm sized well-defined mass with dilation of the upstream bile duct and the pancreatic duct. (C–F) On magnetic resonance imaging, the pancreatic mass demonstrated iso signal intensity and low signal intensity on T2WI and T1WI, respectively. The pancreatic mass with a well-defined margin also demonstrated a double duct sign. However, there was no evidence of adjacent vessel invasion.

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  Fig. 2 Gross findings of the cross-sectioned pancreas head from pancreaticoduodenectomy. A relatively well-defined yellow white solid mass was identified (asterisks). The mass involved pancreas head parenchyma, duodenum, and ampulla of Vater.

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  Fig. 3 Microscopic findings of pancreas head tumor. (A, B) Hematoxylin-eosin-stained slide of a representative tumor area showed malignant tumor cells with solid nests (A) or glandular structure (B) similar to urothelial carcinoma. Immunohistochemistry study revealed that tumor cells were positive for CK7 (C) and GATA-3 (E) but negative for CK20 (D), p63 (F), and PAX-8 (G) (A, B: ×200; C–G: ×100).

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  Fig. 4 Microscopic findings of infiltrating urothelial carcinoma. (A, B) Urothelial carcinoma cells showed high grade nuclear atypia and solid tumor nests (A) or glandular structures (B). Urothelial carcinoma cells were diffuse positive for CK7 (C) and GATA-3 (F) but negative for p63 (G) and PAX-8 (H) in immunohistochemistry studies. Most of tumor cells were also negative for CK20 (D). However, 10% of tumor cells were positive for CK20 (E) (A, B: ×200; C–H: ×100).

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