A Case of Pancreatic Cancer that Recurred as Skin and Muscle Metastases

Abstract

A 49-year-old woman was diagnosed with cancer of the head of the pancreas and underwent subtotal stomach-preserving pancreatoduodenectomy. Postoperative adjuvant chemotherapy consisted of seven cycles of gemcitabine (GEM). Three years and 5 months postoperatively, a painful 30-mm mass appeared in the left chest wall, and since FDG-PET computed tomography showed sites of FDG uptake beneath the skin of the right upper arm and the right gluteus/thigh, in the muscles of the left forearm and left thigh, the left chest wall, and the left dorsal spine muscles, skin and muscle metastases of pancreatic cancer were suspected. This diagnosis was confirmed by excisional biopsy of the chest wall lesion. GEM monotherapy was restarted, but although the metastatic lesions in the skin and muscle regressed temporarily, after completion of the eighth cycle, multiple lesions became apparent, including bone and lymph node metastases. Subsequent chemotherapy was discontinued, and the patient died of the original cancer 4 years 10 months postoperatively, which was 1 year 8 months after the initial recurrence. Only five cases of muscle metastases of pancreatic cancer have been reported in Japan, with only two cases of both types of metastasis, making this condition extremely rare. In those previously reported cases, post-recurrence survival was generally around 6 months, but the present patient survived for over a year with chemotherapy, making this an important case.