Disseminated Metastasis with a History of Pancreatic Carcinoma 15 Years Ago: Diagnostic Challenge

SWK Siu, ANC Kan, GKH Au

Hong Kong J Radiol 2011;14:24-8

We report on a patient with a history of pancreatic carcinoma 15 years ago, who presented with a fever of unknown origin and was subsequently found to have disseminated metastases from an unknown primary. Multiple investigations performed in response to clinical findings and suspicions indicated that they might be metastases from the pancreatic carcinoma resected 15 years earlier, without there being any evidence of recurrence in the intervening period. In view of the patient's progressively deteriorating general condition, she could only be offered best supportive care. Apart from being rare, this case illustrates possible diagnostic approaches when faced with a patient with metastasis from an unknown primary. For patients with disseminated metastatic disease being considered for palliative chemotherapy, it is important to explore all possible means to identify the primary site and obtain histological confirmation, especially if the origin of the primary tumour is in doubt.

中文摘要

十五年前曾患有胰腺癌的患者發現有全身性轉移癌：診斷挑戰

蕭偉君、簡念慈、歐國雄

本文報告一名病人病發時無明顯原因的發燒，其後發現有不明原發腫瘤引致的全身性轉移。患者十五年前曾患有胰腺癌。根據臨床資料替患者作多項檢查結果顯示，雖然這段期間並無任何復發跡象，其轉移瘤應可能十五年前切除了的胰腺癌引發的。由於患者病情逐漸惡化，唯有給予最佳支持治療。這病例除了罕有之外，也說明了當遇上有不明原發腫瘤的病人，醫生可以採用的診斷方法。患有全身性轉移瘤而須接受緩和性化療的病人，應盡可能找出原發腫瘤的位置及確定其組織學資料，尤其是未能確立原發腫瘤的位置時。