CASE REPORT
Introdução: O câncer pancreático é uma malignidade altamente agressiva e refratária, ocupando o sétimo lugar entre as principais causas de mortalidade relacionada ao câncer globalmente. A metástase para o sistema nervoso central (SNC) é excepcionalmente rara em adenocarcinomas, representando apenas uma pequena fração dos casos. Este relato apresenta um caso único de metástase cerebelar em um paciente com adenocarcinoma pancreático moderadamente diferenciado, com o objetivo de esclarecer essa ocorrência incomum. Relato de caso: Paciente masculino, caucasiano, de 55 anos, diagnosticado com adenocarcinoma pancreático e metástase pulmonar, apresentou sintomas neurológicos de início súbito. Estudos de imagem revelaram uma lesão no hemisfério cerebelar direito, que foi cirurgicamente ressecada e analisada histopatologicamente. Avaliação imunohistoquímica foi realizada para verificar a expressão de marcadores associados ao prognóstico. A análise histopatológica confirmou adenocarcinoma moderadamente diferenciado infiltrando o parênquima cerebelar, que indicou positividade para marcadores associados a um pior prognóstico, especialmente MUC1. A intervenção cirúrgica resultou em melhora neurológica progressiva, mas o paciente posteriormente sucumbiu à progressão sistêmica da doença. Conclusão: A metástase para o SNC a partir de um adenocarcinoma pancreático permanece um evento incomum com mau prognóstico. Este caso destaca a importância da intervenção precoce para metástases no SNC quando possível, potencialmente melhorando a qualidade de vida do paciente e prolongando a sobrevida. No entanto, mais pesquisas são necessárias para avaliar o impacto de tais intervenções. Além disso, este relato representa o quarto caso documentado de metástase cerebelar a partir de adenocarcinoma pancreático na literatura médica, contribuindo para nossa compreensão desse fenômeno raro e fornecendo insights para futuras revisões literárias e estratégias de tratamento.
Background: Pancreatic cancer is a highly aggressive and refractory malignancy, ranking as the seventh leading cause of cancer-related mortality globally. Metastasis to the central nervous system (CNS) is exceptionally rare in adenocarcinomas, comprising only a small fraction of cases. This report presents a unique case of cerebellar metastasis in a patient with moderately differentiated pancreatic adenocarcinoma, aiming to shed light on this infrequent occurrence. Case Presentation: Male patient, 55-year-old, Caucasian, diagnosed with pancreatic adenocarcinoma and lung metastasis presented with sudden-onset neurological symptoms. Imaging studies revealed a lesion in the right cerebellar hemisphere, which was surgically resected and histopathologically analyzed. Immunohistochemistry was performed to evaluate marker expression associated with prognosis. Histopathological analysis confirmed moderately differentiated adenocarcinoma infiltrating the cerebellar parenchyma. Immunohistochemistry indicated positivity for markers associated with worse prognosis, notably MUC1. Surgical intervention led to a progressive neurological improvement, but the patient later succumbed to systemic disease progression. Conclusion: CNS metastasis from pancreatic adenocarcinoma remains an uncommon event with a dismal prognosis. This case highlights the importance of early intervention for CNS metastases when feasible, potentially improving the patient’s quality of life and extending survival. However, further research is needed to assess the impact of such interventions. Additionally, this report represents the fourth documented instance of cerebellar metastasis from pancreatic adenocarcinoma in the medical literature, contributing to our understanding of this rare phenomenon and providing insights for future literature reviews and treatment strategies.
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1MS, Medical Student, Universidade Positivo, Curitiba, PR, Brazil.
2MD, Neurosurgeon, Hospital Erasto Gaertner, Curitiba, PR, Brazil.
Received Mar 2, 24
Corrected Apr 13, 2024
Accepted May 28, 2024
