Rapid spread of rare pancreatic cancer to liver detailed in report
Case illustrates importance of proper screening to promote early detection
A rapidly growing pancreatic signet ring cell adenocarcinoma, a rare and aggressive type of pancreatic cancer, was reported to have spread to the liver in less than two months, according to a case report from Staten Island University Hospital researchers.
This case is unusual, according to the team, because the computed tomography (CT) scan of the patient’s abdomen and pelvis did not show any signs of a mass just six weeks earlier. The rapid growth of a large tumor and its distant spread within such a short time illustrates how fast and aggressive this type of pancreatic cancer can be.
“More studies are needed to establish proper screening for pancreatic cancer and to promote early detection with advancements in imaging modalities, especially in patients with unexplained symptoms or in the context of concurrent pancreatitis,” researchers wrote.
Their report, “Rapid Metastatic Growth of A Pancreatic Signet Ring Cell Carcinoma within 6 weeks of A Negative CT,” was published in the European Journal of Case Reports in Internal Medicine.
Pancreatic cancer developed, spread to liver in short time
Signet ring cell adenocarcinoma is a highly aggressive type of cancer typically found in glandular cells responsible for producing and releasing secretions within digestive organs, most commonly the stomach. In rare instances, it affects the pancreas. When examined under a microscope, the cancer cells resemble signet rings, a type of circular seal.
Like other signet ring cell adenocarcinomas, those that develop in the pancreas usually spread rapidly and are difficult to treat. Because it is so rare, much of what is known comes from case reports and small studies, where it is diagnosed at a more advanced stage compared with other types of pancreatic cancer.
In this report, the researchers described the case of a 50-year-old man who developed a large mass in his pancreas along with metastatic spread to the liver in just six weeks. Metastases are cancer cells that have moved from their original site to other organs in the body.
“Although pancreatic cancer often presents with advanced disease at diagnosis, we believe our report is the first to present this pattern of [tumor] progression within six weeks,” the researchers wrote.
Endoscopic ultrasound shows mass in patient’s pancreas
The man visited the emergency department with abdominal pain, fever, nausea, and vomiting. A CT scan at that time showed colon inflammation but no abnormalities in the pancreas or the liver. He was discharged on antibiotics and scheduled for follow-up.
Six weeks later, he returned with abdominal pain located higher in the stomach and radiating to the back. Blood tests showed mild changes, and an abdominal ultrasound was normal. However, a repeat CT scan suggested pancreatitis and revealed suspicious findings in both the pancreas and the liver.
Doctors then performed an endoscopic ultrasound, a test in which a thin tube with an ultrasound probe is passed into the digestive tube to obtain detailed images of the pancreas. The test showed a mass in the pancreas and additional lesions in the liver, both of which were sampled using fine-needle biopsy for examination under a microscope.
This case [emphasizes] both the aggressive nature of pancreatic signet ring cell adenocarcinoma and the diagnostic limitations of CT imaging in detecting early-stage pancreatic cancer.
An MRI confirmed the presence of a mass in the pancreas, multiple lesions in the liver, and changes around nearby blood vessels. Biopsy results established the diagnosis of pancreatic adenocarcinoma with signet ring cell-like features.
The changes between the first negative CT scan and the later findings show how rapidly this type of pancreatic cancer can progress. In patients with persistent abdominal pain, doctors should remain alert even if initial CT scans are negative, the researchers said.
“This case [emphasizes] both the aggressive nature of pancreatic signet ring cell adenocarcinoma and the diagnostic limitations of CT imaging in detecting early-stage pancreatic cancer,” the researchers wrote, noting that more studies are needed to improve its diagnosis. “As individual case reports remain the primary sources of clinical data, the establishment of a [multicenter] collaboration would greatly enhance our understanding of its epidemiology, treatment responses, and clinical [behavior].”
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