Surgical case reports · 2026
A Shared Genomic Alteration Supported the Diagnosis of Two Tumors in the Remnant Pancreas 7 Years after Resection of Distal Cholangiocarcinoma.
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Tamura Hanako, Ueda Hiroki, Kinowaki Yuko, Kato Shu, Shintaku Hiroshi, Asano Daisuke, Ishikawa Yoshiya, Furuyama Takaki, Katsuta Eriko, Akahoshi Keiichi, Ikeda Sadakatsu, Ban Daisuke
Аннотация
INTRODUCTION: Metastatic tumors to the pancreas account for approximately 2% of all pancreatic malignancies, and pancreatic metastasis from distal cholangiocarcinoma is extremely rare. Differentiating pancreatic metastasis of cholangiocarcinoma from primary pancreatic cancer is often difficult, as both typically present as adenocarcinoma with similar immunohistochemical features.
CASE PRESENTATION: A 65-year-old man underwent subtotal stomach-preserving pancreatoduodenectomy (SSPPD) for distal cholangiocarcinoma. He was diagnosed with pT3N0M0, Stage IIB according to the UICC TNM classification, 8th edition. Seven years after surgery, a routine blood test revealed an elevated serum carbohydrate antigen 19-9 level. Abdominal MRI and CT demonstrated 2 small masses, each approximately 10 mm in diameter, in the remnant pancreas without evidence of distant metastasis. Both lesions were diagnosed as adenocarcinoma by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), suggesting either pancreatic metastases from distal cholangiocarcinoma or primary pancreatic cancer in the remnant pancreas. Completion total pancreatectomy with splenectomy was therefore performed. Histopathological examination showed that both lesions in the remnant pancreatic tail were morphologically similar to the initial cholangiocarcinoma. However, the possibility of primary pancreatic cancer could not be completely excluded. Comprehensive genomic profiling (CGP) of the initial cholangiocarcinoma and the remnant pancreatic tumor revealed a shared TP53 H214R alteration, supporting the diagnosis of pancreatic metastases from distal cholangiocarcinoma. In addition, CGP identified BRCA1 loss and an FGFR3 alteration in the remnant pancreatic tumor as potentially actionable findings, although their therapeutic relevance in cholangiocarcinoma remains uncertain.
CONCLUSIONS: We report a rare case of multiple pancreatic metastases occurring 7 years after resection of distal cholangiocarcinoma. Evaluation of genetic alterations provided supportive evidence to aid in distinguishing metastatic disease from primary pancreatic cancer in the remnant pancreas. In addition, these findings also suggested potentially relevant therapeutic targets.
CASE PRESENTATION: A 65-year-old man underwent subtotal stomach-preserving pancreatoduodenectomy (SSPPD) for distal cholangiocarcinoma. He was diagnosed with pT3N0M0, Stage IIB according to the UICC TNM classification, 8th edition. Seven years after surgery, a routine blood test revealed an elevated serum carbohydrate antigen 19-9 level. Abdominal MRI and CT demonstrated 2 small masses, each approximately 10 mm in diameter, in the remnant pancreas without evidence of distant metastasis. Both lesions were diagnosed as adenocarcinoma by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), suggesting either pancreatic metastases from distal cholangiocarcinoma or primary pancreatic cancer in the remnant pancreas. Completion total pancreatectomy with splenectomy was therefore performed. Histopathological examination showed that both lesions in the remnant pancreatic tail were morphologically similar to the initial cholangiocarcinoma. However, the possibility of primary pancreatic cancer could not be completely excluded. Comprehensive genomic profiling (CGP) of the initial cholangiocarcinoma and the remnant pancreatic tumor revealed a shared TP53 H214R alteration, supporting the diagnosis of pancreatic metastases from distal cholangiocarcinoma. In addition, CGP identified BRCA1 loss and an FGFR3 alteration in the remnant pancreatic tumor as potentially actionable findings, although their therapeutic relevance in cholangiocarcinoma remains uncertain.
CONCLUSIONS: We report a rare case of multiple pancreatic metastases occurring 7 years after resection of distal cholangiocarcinoma. Evaluation of genetic alterations provided supportive evidence to aid in distinguishing metastatic disease from primary pancreatic cancer in the remnant pancreas. In addition, these findings also suggested potentially relevant therapeutic targets.