Single pancreatic and multiple hepatic metastases developing 6 years after left hemicolectomy for colon cancer - A case report

Sep 24, 2026

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A 50-year-old woman presented with a pancreatic tumor and multiple hepatic tumors identified via computed tomography (CT). Six years earlier she underwent surgical resection for colon cancer, and three years earlier she had resection of a metastatic lung tumor. Primary pancreatic cancer with liver metastases was suspected, but pancreatic metastasis from the prior colon cancer also had to be considered. Imaging could not discriminate the origin, so endoscopic ultrasound-guided fine-needle aspiration and immunohistochemistry were used. Adenocarcinoma with cytokeratin 20 positivity and negative cytokeratin 7, supported pancreatic metastasis of colonic origin; liver biopsy corroborated the diagnosis. Chemotherapy was initiated after diagnosis.

LanguageEnglish

CategoryHealthcare

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Case report

| Fukushima J. Med. Sci.,
Vol. 72, No. 2, 2026 | | | | --- | --- | --- | [Case Report] Single pancreatic and multiple hepatic metastases developing 6 years after left hemicolectomy for colon cancer: A case report Eisuke Kameoka1)2), Takuto Hikichi3), Naoki Konno1), Hiroyuki Asama1)2), Kenta Kodama1), Jun Nakamura2)3), Daiki Nemoto2)3), Tsunetaka Kato2)3), Takumi Yanagita2)3), Mitsuru Otsuka2), Masao Kobayakawa3)4), Kazuhiro Tasaki5) and Hiromasa Ohira2) 1)Department of Gastroenterology, Japanese Red Cross Society Fukushima Hospital, 2)Department of Gastroenterology, Fukushima Medical University School of Medicine, 3)Department of Endoscopy, Fukushima Medical University Hospital, 4)Medical Research Center, Fukushima Medical University, 5)Department of Diagnostic Pathology, Japanese Red Cross Society Fukushima Hospital (Received May 1, 2025, accepted July 24, 2025) Abstract A 50-year-old woman presented with a pancreatic tumor and multiple hepatic tumors identified via computed tomography (CT) . The patient had undergone surgical resection for colon cancer 6 years earlier, followed by resection of a metastatic lung tumor 3 years ago. In the current presentation, primary pancreatic cancer with metastatic hepatic tumors was initially suspected. However, the possibility of previously resected colon cancer metastasizing to the pancreas also had to be considered. CT findings alone could not make this distinction. Therefore, endoscopic ultrasound-guided fine-needle aspiration was performed. Histopathological examination of the pancreatic tumor indicated adenocarcinoma, with features similar to those of the previously resected colon cancer. Immunohistochemical staining was negative for cytokeratin 7 but positive for cytokeratin 20, caudaltype homeobox 2, and special AT-rich sequence-binding protein 2. These findings indicated a pancreatic metastasis of colonic origin. In addition, a percutaneous ultrasound-guided biopsy of oneof the hepatic tumors had histopathological findings that were similar to those of the pancreatic tumor. Hence, the patient was diagnosed with pancreatic and hepatic metastases from the previously resected colon cancer. Chemotherapy was initiated after this diagnosis. Key words : colon cancer, endoscopic ultrasound-guided fine-needle aspiration, immunohistochemical staining, pancreatic cancer, pancreatic metastasis Introduction Pancreatic metastases account for approximately 2% of all malignant pancreatic neoplasms1) . Renal cell carcinoma is the most common primary origin of pancreatic metastases, accounting for 61.7% of all cases, followed by colon cancer at 7 .8%2) . Imaging findings, including those from computed tomography (CT), ultrasonography, endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP), for pancreatic metastases of colon cancer include well-demarcated masses, compressive stenosis of the main pancreatic duct, and goblet-like interruption of the main pancreatic duct caused by tumor invasion or obstruction. However, these findings are not specific to metastatic colon cancer3,4) . In cases with a solitary pancreatic tumor, it is challenging to differentiate between primary pancreatic cancer and pancreatic metastasis based only on Corresponding author : Takuto Hikichi, MD, [PhD. E](PhD. E-mail : takuto@fmu.ac.jp)[-](PhD. E-mail : takuto@fmu.ac.jp)[mail : takuto@fmu.ac.jp](PhD. E-mail : takuto@fmu.ac.jp) ©2025 The Fukushima Society of Medical Science. This article is licensed under a Creative Commons [Attribution-NonCommercial-ShareAlike 4.0 International] license. [https://creativecommons.org/licenses/by](https://creativecommons.org/licenses/by-nc-sa/4.0/)[-](https://creativecommons.org/licenses/by-nc-sa/4.0/)[nc](https://creativecommons.org/licenses/by-nc-sa/4.0/)[-](https://creativecommons.org/licenses/by-nc-sa/4.0/)[sa/4.0/](https://creativecommons.org/licenses/by-nc-sa/4.0/) 164 E. Kameoka et al. the findings of imaging

FAQs

Why was it difficult to determine whether the pancreatic tumor was primary cancer or metastasis?

CT and other imaging findings were not specific enough to distinguish primary pancreatic cancer from pancreatic metastasis from colon cancer.

What diagnostic procedure established the tumor origin in this case?

Endoscopic ultrasound-guided fine-needle aspiration with histopathological and immunohistochemical evaluation identified adenocarcinoma consistent with the previously resected colon cancer.

How did the liver biopsy contribute to the final diagnosis and treatment plan?

A percutaneous ultrasound-guided biopsy of a hepatic lesion showed histopathological findings similar to the pancreatic tumor, supporting pancreatic and hepatic metastases from the prior colon cancer, after which chemotherapy was initiated.

Sep 24, 2026

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