Int J Thyroidol.  2021 Nov;14(2):175-179. 10.11106/ijt.2021.14.2.175.

A Newly Developed Pancreatic Adenocarcinoma in a Patient with Advanced Thyroid Cancer under Long-Term Sorafenib Use

• Kim MJ
• Baek HS
• Lee SH
• Lim DJ

• KMID: 2522923
• DOI: http://doi.org/10.11106/ijt.2021.14.2.175

Abstract

Sorafenib, an oral multi-target tyrosine kinase inhibitor (MTKI) for treatment of radioiodine-refractory differentiated thyroid cancer can induce acute or chronic pancreatitis as an adverse event. However, there have been no reports of pancreatic cancer associated with MTKI, especially among long-term MTKI user. A 60-year-old male patient visited our outpatient cancer clinic due to aggravated abdominal and back pain. He had been taking sorafenib for over five years for advanced thyroid cancer with multiple lung metastases, without any adverse events except mild hand-foot syndrome and slightly increased liver enzymes at the initial phase. Laboratory findings showed increasing serum amylase and lipase levels. An abdominal CT scan showed a 5.2 cm heterogeneous hypointense mass-like lesion on the pancreas distal body area. Under suspicion of pancreatic cancer, extensive surgery of distal pancreatectomy, unilateral nephrectomy, and unilateral adrenalectomy confirmed moderately differentiated adenocarcinoma with a background of chronic pancreatitis accompanying fibrosis and fat necrosis. Pancreatic cancer should be considered as well as pancreatitis in long-term MTKI users who show abrupt increases in serum pancreatic enzymes, although a causal relationship between long-term MTKI use and pancreatic cancer has not been elucidated.

Keyword

Thyroid carcinoma; Sorafenib; Pancreatic carcinoma; Adverse drug event

Figure

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  Fig. 1 Chest CT scan shows partial response of multiple lung metastases from advanced papillary thyroid carcinoma five and a half years after treatment with sorafenib.

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  Fig. 2 Abdominal CT scan shows a non-enhanced hypointense lesion in the distal body of the pancreas (solid arrow), with an accompanying slightly enhanced area (open arrow) in the pancreatic tail, suspicious of pancreatic cancer with surrounding inflammation (A). PET/CT scan reveals a focal hypermetabolic uptake in the distal body of the pancreas (arrow) (B).

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  Fig. 3 Gross images of radical antegrade modular pancreatosplenectomy (RAMP), left nephrectomy, and left adrenalec-tomy. The RAMP specimen reveals an irregular whitish lesion suspicious for invasive tumor accompanying inflammation (A). The left kidney shows a pale yellow to whitish area near the Gerota’s fascia, suggesting fat necrosis (B).

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  Fig. 4 Microscopic images of pancreatic ductal adenocarcinoma with underlying chronic pancreatitis. Microscopic findings show infiltrating well-to-moderately differentiated ductal adenocarcinoma with desmoplastic stroma (A) and perineural invasion (B). Background pancreatic tissue revealed advanced chronic pancreatitis replacing acinar parenchyma with fibrosis (C) and focal necrotic areas (D). Kidney tissue showed chronic inflammation with fibrosis near the Gerota’s fascia (E). The adjacent perirenal adipose tissue indicated fat necrosis (F).

Reference

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