Lung resection for metastasis from cancer of the papilla of vater after pancreaticoduodenectomy—report of a case—

Abstract

The patient was a woman in her seventies undergone pylorus preserving pancreaticoduodenectomy for cancer of the papilla of Vater. The histological diagnosis was tubular adenocarcinoma, moderately differentiated, AbpBi, H0, pPanc0, pDu2, P0, PN1(+)(only 13b), M(-), St(-), pT3, and stage III. While she had been followed in the clinic, a chest CT scan taken 2 years after the operation showed a 2cm-sized solitary abnormal shadow in the right lung S2. Bronchoscopic cytodiagnosis resulted in class II, but FDG-PET showed a significantly abnormal accumulation of FDG. Abdominal and head CT scans as well as bone scintigram showed no abnormal findings. From these findings, upper lobectomy of the right lung was performed with the most likely diagnosis of primary lung cancer. Finally lung metastasis from cancer of the papilla of Vater was diagnosed based on epithelial proliferation into the alveolar cavity on the resected specimen, histopathological findings including secondary formation of tubular glands, and results of immunostaining.
Cancer of the papilla of Vater can metastasize locally or can do to the lymph nodes, the liver and the lung after the operation, which are considered to be usual metastatic patterns. However, postoperative solitary metastasis to the lung which is treated by lung resection is rare, so that this case is reported here, together with a review of the literature.