Pancreaticoduodenectomy for Pancreatic Metastases of Malignant Fibrous Histiocytoma

doi:10.4236/ss.2013.411098

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Surgical Science, 2013, 4, 506-508

Published Online November 2013 (http://www.scirp.org/journal/ss)

http://dx.doi.org/10.4236/ss.2013.411098

Open Access SS

Pancreaticodu odenectomy for Pancreatic Metastases of

Malignant Fibrous Histiocytoma*

Jing Zhu, Huihua Cai#, Donglin Sun

Department of Hepatobiliary Surgery, The First People’s Hospital of Changzhou, Soochow University,

Changzhou, China

Email: #[email protected]

Received October 7, 2013; revised November 5, 2013; accepted November 13, 2013

permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Unlike primary pancreatic carcinoma, metastases to the pancreas are rare and their resection may be performed as a

palliative treatment due to poorly defined outcome. We herein present an extremely rare case of pancreatic metastases

of malignant fibrous histiocytoma (MFH) undergoing pancreaticoduodenectomy with tumor-free survival within post-

operative 35-month follow-up. Pancreatic resection for metastatic MFH to the pancreas should be considered in selected

patients. Long-term survival or good palliation may be achieved.

Keywords: Pancreaticoduodenectomy; Pancreatic Metastasis; Malignant Fibro us Histiocytoma

1. Introduction

The pancreas has been found to be a rare site of metasta-

sis with malignant tumor; the kidney, breast, lung, colon,

and skin are the most common sites of the primary tumor

[1]. So the quantity of literatures of pancreatic metasta-

sis (PM) of malignant fibrous histiocytoma (MFH) is

very limited and only a few cases have been reported in

the world till now [2-5]. In this repo rt we will describe a

patient suffering from isolated pancreatic metastasis of

MFH, and the clinical features of the treatme nt. The out-

comes are also discussed.

2. Case Report

The patient was a 69-year-old male. His past medical

history showed that he had undergone lumpectomy in the

left back at anoth er hospital in May 2006, and MFH was

diagnosed by pathologic examination. Unfortunately, he

suffered from another two radical operation because of

local recurrence on June 21, 2006 and October 31, 2006

respectively. Local radiotherapy was followed by the

third operation and relapse was no longer found in the

back.

He was admitted to our hospital on October 8, 2008

because of expectorated blood-tinged sputum intermit-

tently for a month. Lower left lung mass was prompted

by chest radiography and CT. The left lower pulmonary

lobectomy was performed on October 13 and postopera-

tive pathology indicated metastatic MFH (Figure 1).

Three courses of CAP (CTX/ADM/DDP) regimen

chemotherapy were additionally treated after pulmonary

lobectomy and the regular re-examination prompted a

stable condition un til June 2010. He presen ted abdominal

pain for three days and CT indicated a tumor in the head

of the pancreas. The values of serum CEA, CA 19-9, CA

15-3 were within normal laboratory range. Without con-

traindications, pancreaticoduodenectomy was performed

on June 28, 2010, and metastatic malignant fibrous his-

tiocytoma of the head of the pancreas was proved by pos-

toperative pathology (Figure 1). The patient recovered

from the operations without complications and has been

remaining free of tumor in follow-up 35 months (Figure

2).

3. Discussion

Unlike primary pancreatic carcinoma, metastatic lesions

to the pancreas are rare, accounting for less than 5% of

all pancreatic neoplasms [6] and approximately 2% of

pancreatic malignancies [1,7]. Patients with pancreatic

metastases are often asymptomatic and detected inciden-

tally or during follow-up investigations even several

*Competing interest: no benefits in any form have been received or will

be received from a commercial party related directly or indirectly to the

subject of this article.

#Corres

ondin

author.

J. ZHU ET AL. 507

Figure 1. The cell feature of our case was a pleomorphic cell

arranged in a storiform pattern. The areas of malignant

fibrous histiocytoma infiltrating the pulmonary and pan-

creatic tissue are shown. (H&E staining. Upper: pulmonary

metastasis of MFH; Down: pancreatic metastasis of MFH).

Figure 2. A computed tomography scan of the abdomen

showing the tumor in the head of the pancreas (Left). No

local recurrence or distant metastasis was noted during

follow-up of 29 months (Right).

years after the removal of the primary tumor. The pri-

mary tumors are most commonly located in kidney,

breast, lung, and colon cancers, or more rarely, gastric

cancer, melanoma, and sarcoma [1,8-10].

Malignant fibrous histiocytoma (MFH) has been re-

garded as one of the most common sarcoma tumors in

soft tissue since the introduction of the concept of facul-

tative fibroblasts by Ozzello et al. [11] in 1963. This tu-

mor has a high likelihood of metastasis and recurrence

and the most common sites of occurrence are the up-

per/lower limbs, trunk followed by the chest and retrop-

eritoneal cavity. But pancreatic metastasis secondary to

MFH of is extremely uncommon. Up to date, there are a

few sporadic cases reported, using a systematic Pub Med

search [2-5].

However, it is still controversial whether the patients

with PM should take the surgical treatment or not. But

some recent literatures [12,13] suggest that patients with

isolated PM can benefit from surgery and pancreatic re-

section may achieve long-term survival or good pallia-

tion in selected cases. The surgical complications and

perioperat i ve mortality of PM have no obvious diffe rence

with that of pancreatic primary tumors. The following

criteria for the selection of patients for pancreatic metas-

tasectomy are suggested: 1) primary cancer types that are

associated with successful outcomes, 2) control of the

primary cancer site, 3) isolated metastases, 4) resectabil-

ity of the metastasis, 5) patient fitness to tolerate pancre-

atectomy.

Despite the poor radiation sensitivity of MFH, radio-

therapy is still the main means of adjuvant therapy to

control local recurrence [14]. But the efficacy of chemo-

therapy is still controversial. Some researchers contended

that concurrent adjuvant chemotherapy and radiotherapy

might be an effective treatment for MFH [15]. However,

Gutierrez [14] suggested that surgical resection and ra-

diotherapy are unique among treatment modalities in

association with a significant su rvival benefit, rather than

chemotherapy.

4. Conclusion

In our experience, the patient underwent three local op-

erations in the left inferior back and pulmonary lobec-

tomy due to recurrence or metastasis from MFH. Resec-

tion of pulmonary metastases from sarcoma has been

studied extensively and can improve long-term survival.

In an independent study, the 5-year disease-free survival

in similar patients was reported to be 41% [16]. Pancreas

solitary metastasis occurred in more than two years after

pulmonary resection. Solitary metastasis to the pancreas

occurs less frequently; in fact, there are few reports con-

cerning solitary resectable metastatic tumors of the pan-

creas. In the Mayo clinic series [10], only 27 out of 1357

patients (2%) with solitary pancreatic masses had secon-

dary pancreatic tumor, and only four of them were re-

sected. Pancreaticoduodenectomy was performed in our

patient successfully. He recovered from operation with-

out complications and remains free of tumor within 35-

month follow-up. Surgical resection has been regarded as

the best therapeutic option to improve the long-term sur-

vival of patients with isolated pancreatic metastasis. Ad-

juvant radiotherapy is still a helpful tool to control local

recurrence. The clinical effect of chemotherapy needs to

be verified in further research.

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