A Case of Pleomorphic-Type Anaplastic Carcinoma of the Pancreas with Rapidly Progressive and Fatal Cardiac Metastasis

Sep 30, 2026

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Cardiac metastasis from pancreatic ductal adenocarcinoma is extremely rare, and pleomorphic-type anaplastic carcinoma of the pancreas (PACP) is an uncommon, highly aggressive variant with poor prognosis. This case report details the first described PACP patient with antemortem diagnosis of cardiac metastasis and a rapidly fatal course. After resectable disease was treated with neoadjuvant and curative surgery, the tumor rapidly progressed within months, leading to sudden cardiac arrest and death.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Abstract

Introduction

Case Presentation

Conclusions

SURGICAL CASE REPORTS Surg Case Rep 2026; 12: 25-0567 Case Report A Case of Pleomorphic-Type Anaplastic Carcinoma of the Pancreas with Rapidly Progressive and Fatal Cardiac Metastasis Keiichi Shigematsu,1 Shingo Kozono ,1 Atsushi Fujii,1 Norimasa Abe,1 Hirotaka Kuga,1 Sadafumi Tamiya,2 and Toru Nakano1 ABSTRACT INTRODUCTION: Cardiac metastasis from pancreatic ductal adenocarcinoma (PDAC) is extremely rare. Pleomorphic-type anaplastic carcinoma of the pancreas (PACP) is an uncommon, highly aggressive PDAC variant with lymphatic and hematogenous spread and poor prognosis. We report, to our knowledge, the first PACP case with antemortem diagnosis of cardiac metastasis and a rapidly fatal course. CASE PRESENTATION: A 75-year-old man presented with left hypochondrial pain. CT showed a 4-cm, gradually and heterogeneously enhancing pancreatic tail mass without distant metastasis. Gadolinium-enhanced MRI demonstrated peripheral progressive enhancement with internal non-enhancing areas, suggesting a non-conventional PDAC. Ultrasound-guided fine needle aspiration (EUS-FNA), nevertheless, yielded mainly scattered atypical epithelial cells with a small cohesive columnar component, and adenocarcinoma was diagnosed; further subclassification was not feasible on the limited cytologic material. Because the tumor was radiologically resectable, neoadjuvant gemcitabine plus S-1 was administered. Follow-up CT showed enlargement to 5.5 cm, new invasion of the spleen and gastric wall, and peripheral progressive enhancement—previously demonstrated on MRI—now appreciable on CT, while distant disease remained absent. Distal pancreatectomy with splenectomy, regional lymphadenectomy, and partial gastrectomy was performed. The resected specimen revealed a whitish solid tail tumor with focal hemorrhage/necrosis; histology confirmed PACP. Adjuvant S-1 was initiated 1 month postoperatively. Three months after surgery, CA19-9 increased despite no recurrence on CT. One month later he presented with exertional dyspnea and complete atrioventricular block. Echocardiography and CT showed an approximately 8-cm interatrial mass and a left-ventricular wall lesion. Retrospective review of CT performed 1 month earlier identified a 2-cm atrial nodule at the same site, indicating very rapid intracardiac growth. He was transferred to a cardiovascular center for planned pacemaker implantation, and heart-failure therapy was initiated first. During preparation he developed sudden cardiac arrest and died. Postmortem myocardial biopsy confirmed PACP metastasis. CONCLUSIONS: Clinicians need to recognize that PACP can metastasize to the heart and incorporate this risk into routine follow-up, maintaining vigilance for imaging features suggestive of cardiac involvement and for new-onset cardiac symptoms or conduction disturbances; when cardiac metastasis is suspected, prompt evaluation and intervention are warranted. 1Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan 2Department of Pathology, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan Corresponding author: Shingo Kozono. Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka 802-0077, Japan E-mail: [shingo_kozono01@kitakyu-cho.jp](shingo_kozono01@kitakyu-cho.jp) Received: September 12, 2025; Accepted: December 7, 2025 DOI: 10.70352/scrj.cr.25-0567 © 2026 The Author(s) . Published by Japan Surgical Society This article is licensed under a Creative Commons Attribution 4.0 International License. Shigematsu K. et al. KEYWORDS: pancreatic ductal adenocarcinoma, cardiac metastasis, pleomorphic-type anaplas tic carcinoma of the pancreas, undifferentiated carcinoma of the pancreas Abbreviations CA19-9 CEA CRPEUS-FNA NAC PACP PDAC WBC carbohydrate antigen 19-9 carcinoembryonic antigen C-reacitive protein ultrasound-guided fine needle aspiration neoadjuvant chemotherapy pleom

FAQs

Why is cardiac metastasis in this setting clinically important?

Cardiac metastasis from pancreatic ductal adenocarcinoma is extremely rare, and this report shows PACP can metastasize to the heart with a rapidly fatal course. Clinicians should incorporate this risk into routine follow-up and remain alert to new cardiac symptoms or conduction disturbances.

What diagnostic findings indicated a non-conventional pancreatic cancer initially?

CT showed a heterogeneously enhancing pancreatic tail mass, and gadolinium-enhanced MRI demonstrated peripheral progressive enhancement with internal non-enhancing areas, suggesting a non-conventional PDAC. EUS-FNA yielded mainly atypical epithelial cells and a small cohesive columnar component, leading to an adenocarcinoma diagnosis without feasible further subclassification.

How did the cardiac metastasis evolve after treatment?

After distal pancreatectomy with splenectomy and partial gastrectomy followed by adjuvant S-1, CA19-9 increased despite no recurrence on CT. Within about one month, the patient developed exertional dyspnea and complete atrioventricular block; imaging showed a large interatrial mass and a left-ventricular lesion, and retrospective review identified an atrial nodule already present one month earlier.

Sep 30, 2026

Uploaded by Margaret