A 70-year-old woman with pancreatic ductal
adenocarcinoma was initially treated by distal
pancreatectomy (DP). Thirty-five months later, another
tumor appeared in the pancreatic head and was treated by
pancreaticoduodenectomy. Histopathological findings identified both
tumors as pancreatic ductal
adenocarcinoma pStage IA. Computed tomography (CT) of the chest 16 months after the second
pancreatectomy revealed a ground-glass opacity in segment 3 of the right lung. Chest CT 23 months after the second
pancreatectomy revealed a nodular shadow in segment 1a of the right lung. Chest CT 39 months after the second
pancreatectomy revealed a nodular shadow in segment 5 of the left lung. These lesions were treated by video-assisted thoracoscopic surgery partial resection. Histopathological and immunohistochemical features (positive for
cytokeratin (CK)7 and CK20, negative for
transcription factor-1) for these three lesions and the secondary pancreatic ductal
adenocarcinoma were similar, indicating a diagnosis of lung
metastasis from the second pancreatic ductal
adenocarcinoma. The patient has remained alive and free of new
metastases for 8 years after initial DP, 3 years after the last lung resection.
CONCLUSION: