胰腺癌可以是侵袭性的并且通常转移到各种器官。最常见的是,胰腺癌转移到肺部,肝脏,骨头,还有腹膜,但很少扩散到腹壁或骨骼肌。在这种情况下,我们讨论了一名患者,该患者最初因胰头腺癌而出现体重减轻和黄疸,后来转移到腹直肌。一名63岁的女性出现黄疸和体重减轻。CT成像显示有2.8厘米的胰头肿块,胰腺和胆管导管扩张。还发现碳水化合物抗原19-9(CA19-9)水平升高至1810U/mL。随后进行了超声内镜引导下的活检,并证实了胰腺腺癌。在接受新辅助FOLFIRINOX化疗的初始治疗后,患者接受了Whipple胰十二指肠切除术。按照Whipple程序,患者接受了辅助化疗,随后的影像学检查显示无复发,CA19-9水平降低至46U/mL.八个月后,患者再次出现下腹痛。发现重复CA19-9水平已增加至1503U/mL。进行了重复正电子发射断层扫描成像,显示左侧腹直肌质量为4.7cm。后来对肿块进行了活检,病理显示复发,转移性胰腺腺癌。患者重新开始紫杉醇和吉西他滨化疗,导致肿瘤大小和CA19-9水平减少135U/mL。然而,由于仅在4个月后肿瘤体积增大,后来进行了手术切除.此时,有限的文献报道了胰腺癌转移到腹壁的发生。在文献综述中,迄今为止仅报告了五例病例,只有两例涉及骨骼肌。我们的罕见病例是首次记录胰腺头引起的胰腺腺癌腹直肌转移。
Pancreatic cancer can be aggressive and commonly metastasizes to various organs. Most commonly, pancreatic cancer metastasizes to the lung, liver, bones, and peritoneum, but very rarely does it spread to the abdominal wall or skeletal muscle. In this case, we discuss a patient who initially presented with weight loss and jaundice from a pancreatic head adenocarcinoma that later metastasized to the rectus abdominis muscle. A 63-year-old female presented with jaundice and weight loss. CT imaging revealed a 2.8 cm pancreatic head mass with pancreatic and biliary ductal dilation. Carbohydrate antigen 19-9 (CA 19-9) level was also found to be elevated to 1810 U/mL. An endoscopic ultrasound-guided biopsy was later performed and confirmed pancreatic adenocarcinoma. The patient underwent a Whipple pancreatoduodenectomy following initial treatment with neoadjuvant FOLFIRINOX chemotherapy. Following the Whipple procedure, she received adjuvant chemotherapy and subsequent imaging revealed no recurrence and decreased CA 19-9 level to 46 U/mL. Eight months afterward, the patient presented once again with lower abdominal pain. Repeat CA 19-9 level was found to have increased to 1503 U/mL. Repeat positron emission tomography scan imaging was performed and showed a 4.7 cm left rectus abdominis muscle mass. The mass was later biopsied, and pathology revealed recurrent, metastatic pancreatic adenocarcinoma. The patient was restarted on chemotherapy with paclitaxel and gemcitabine leading to a reduction in tumor size and CA 19-9 levels of 135 U/mL. However, surgical resection was later pursued due to increased tumor size only four months later. At this time, limited literature is available reporting the occurrence of pancreatic cancer metastasizing to the abdominal wall. Upon literature review, only five cases have been reported to date, and only two of the cases involved the skeletal muscle. Our rare case is the first-time documentation of rectus abdominis metastasis from pancreatic adenocarcinoma arising from the pancreatic head.