**11. Pancreatic cancer from sarcomas**

Pancreatic oligometastases with uterine cervix origin is another rare situation, a successful resection of such a lesion being reported for the first time by Wastell et al. in Westminster, London. The authors reported the case of a patient who had been initially treated by radiotherapy with curative intent for a squamous cell carcinoma; however, 5 years later, the patient was diagnosed with a pancreatic head tumor. At that moment a pancreatoduodenectomy was performed, the histopathological studies confirming the metastatic origin of this lesion; unfortunately the postoperative course was complicated by the apparition of a bronchopneu-

Another interesting case was reported by the Japanese authors in 2013 [59]. The authors reported the case of a 44-year-old patient who had been initially diagnosed with a stage IB uterine cervix cancer, the histopathological studies reporting a mixed adeno-neuroendocrine carcinoma; 8 years later, the patient was diagnosed with an isolated pancreatic tumor which was biopsied, a metastatic neuroendocrine tumor being revealed. At that moment a central pancreatectomy was performed, the histopathological studies confirming the presence of a metastatic lesion; however, only the neuroendocrine component seems to be responsible for the apparition of the recurrent disease. The long-term outcomes were favorable, the patient

Lung cancer is associated with the highest mortality rates, being associated most often with

Pancreatic metastases from lung cancer are not a usual condition; in a review of 333 cases diagnosed with pancreatic metastases, the most common origin of the pancreatic lesions was represented by the renal cell carcinomas, being responsive for 45% of cases; among the remaining cases, the lung was reported as the origin of the pancreatic metastases in 14.7%

When it comes to the most common histopathological subtype of lung cancer which might induce the apparition of pancreatic lesions, small cell lung cancer has been most often reported; other incriminated histopathological subtypes included large cell carcinomas, squa-

When diagnosed, pancreatic metastases from lung cancer are usually encountered as part of the systemic recurrence, with metachronous character; therefore the patient will be a candidate for palliative oncologic treatment, with low rates of long-term survival. Oligometastatic pancreatic disease with lung cancer origin appears in rare situations and it seem to be best treated through surgery with curative intent; however, the longterm outcomes failed to demonstrate good survival rates, the median overall survival ranging from a few months to a few years [10] due to biological aggressiveness of the

monia, the patient being dead 16 days later [58].

144 Advances in Pancreatic Cancer

being free of disease at a 7 month follow-up [59].

liver, brain, bone or lymph node metastases [60].

of cases [61].

primary tumor.

**10. Pancreatic metastases from lung cancer**

mous cell carcinomas and anaplastic bronchial carcinomas [62].

Metastatic lesions with sarcomatous origin are usually associated with an extremely poor outcome due to the biological aggressiveness of such primaries. When encountered, pancreatic metastases with sarcomatous origin are reported as part of the systemic disease so most often surgery is no longer a valid therapeutic option. In cases presenting oligometastatic disease, surgery might be proposed whenever the biological status of the patient will permit it. A particular problem in such cases is related to the multifocality of such lesions and to the feasibility of resection with curative intent [7].

Successful resection of pancreatic metastases from soft tissue sarcomas has been reported by the Japanese authors in two cases. The first patient had been initially diagnosed with a mesenchymal chondrosarcoma of the left thigh in 1986; 3 years later, the patient was diagnosed with isolated pancreatic lesions, the patient being submitted to surgery with curative intent; the patient remained alive for the next 10 years. The second case was initially diagnosed with a synovial sarcoma followed by pulmonary resection for metastatic disease; the case was further diagnosed with a solitary pancreatic lesion for which she was submitted to pylorus preserving pancreatoduodenectomy with good results, the patient remaining alive for more than 6 years after pancreatic resection [63].

Another extremely interesting situation was reported by another Japanese team in 2016. The authors reported the case of a 44-year-old woman who had been previously submitted to surgery for a right fibular head osteosarcoma; 3 years later, the patient was diagnosed with a metastasis in the distal pancreas, so a laparoscopic distal pancreatectomy with spleen preservation was successfully performed; the histopathological studies confirmed the metastatic origin from the initial osteosarcoma. Although the patient also reported the apparition of lung metastases, 1 year later, she was resubmitted to surgery with curative intent, the patient being still alive at the time of publishing the case [64].

A particular situation is represented by patients diagnosed with pancreatic metastases from uterine sarcomas, in cases presenting oligometastatic disease, surgery being considered as a valid option. Most often these lesions occur in patients who had been previously diagnosed with uterine leiomiosarcomas and might experience good long-term outcomes whenever a curative resection is performed [65, 66].
