Pulmonary Adenocarcinoma Occurring 5 Years after Resection of a Primary Pancreatic Adenocarcinoma: A Relevant Differential Diagnosis

Ductal adenocarcinoma of the pancreas is a lethal disease. Surgical extirpation only offers the slim chance for long-term survival in localized disease. We report on a 73 year old female patient who initially underwent successful resection of pancreatic adenocarcinoma in May 2005. She was treated with adjuvant chemotherapy with gemcitabine. In October 2010 the patient noticed increasing dyspnea with haemoptysis. She was soon referred to our center. After the diagnosis of pulmonary adenocarcinoma with widespread metastasis, she was treated with systemic chemotherapy. For a period of next three years, she was treated with different chemotherapy regimens due to repeated episodes of tumor progression. To the best of our knowledge after reviewing the literature, this case represents an unusually clinical course with metachronous pulmonary adenocarcinoma arising after treatment of a primary pancreatic cancer after a long latency period. 1. Main Article The patient had undergone distal pancreatectomy with portal vein resection for pancreatic body cancer in early May 2005. At the time of pancreatectomy, the cancer was confined to the organ and had not invaded the portal-splenic vein junction. To ensure an adequate surgical margin, subtotal distal pancreatectomy was performed. Histopathological examination revealed an invasive well-differentiated ductal adenocarcinoma of the pancreas. Adjuvant chemotherapy with gemcitabine was administered. All follow-up reevaluations showed no signs of tumor recurrence, and external laboratory tests did not show elevated CA 19-9 levels. In October 2010, she was referred to our center due to the increasing dyspnea with haemoptysis. Contrast-enhanced tomography revealed a major pulmonary mass in the right upper lobe with contralateral metastases (Figure 1(a)). Macroscopic histologic workup revealed tumor nodule measured 1.3？cm in maximum diameter and it was sharply demarcated. Histological examination revealed a well-differentiated adenocarcinoma with lepidic, papillary, and acinar growth patterns and intracellular and extracellular mucin production. A curative tumor resection was not feasible. First line systemic chemotherapy with carboplatin and pemetrexed was initiated. After five months, stable disease was achieved (Figure 1(b)). Figure 1: Contrast-enhanced tomography revealed a major pulmonary mass within the right upper lobe (arrow) (a). Stable disease was achieved under first line therapy with carboplatin and pemetrexed (b). CT-evaluation revealed tumor progression of the pulmonary mass and metastases, huge pleural