A Case of Isolated Metastatic Pancreatic Cancer from Postoperative Gastric Cancer

We report a case of metastatic pancreatic carcinoma of gastric origin. A 77-year-old man with acute abdomen was admitted in March 2005, at emergency surgery, a fist-sized tumor was found in the upper portion of the lesser curvature of the stomach. Based on pathological findings, he was diagnosed with advanced gastric carcinoma and underwent total gastrectomy in April 2005. Pathological examination of the gastric tumor showed undifferentiated gastric carcinoma. Ten months after S-1 administration was started for postoperative adjuvant chemotherapy, a solitary tumor appeared at the tail of the pancreas and grew locally thereafter until surgically removed. Grossly, the resected lesion was a solid, whitish tumor about 7 cm in diameter. Pathological examination of the pancreatic tumor showed metastatic carcinoma, restricted to the pancreas, of gastric origin. This patient has survived without recurrence for seven months to date, but is suspected of recurrence to the left renal hilar region despite continuing chemo therapy. There are rare cases in which metastatic pancreatic cancer has led to gastric cancer, and metastatic pancreatic tumor conventionally manifests systemic signs of malignancy. Since chemotherapy with anticancer agents is continually progressing, when an isolated lesion is recognized as in this case, we should evaluate the indications for surgical treatment when other organic metastases are not recognized