A257 PANCREATOBILIARY CANCER WITH UNUSUAL SITE OF METASTASIS

• Published in: Journal of the Canadian Association of Gastroenterology 2018-03, Vol.1 (suppl_1), p.446-447
• Main Authors: Alageeli, M H, Qumosani, K
• Format: Article
• Language: English
• Subjects: Poster Presentations
• ISSN: 2515-2084; 2515-2092
• DOI: 10.1093/jcag/gwy008.258

Abstract Background Pancreatobiliary cancer can present as a locally advanced tumor or with distal metastasis. The common sites for metastases are the liver, lungs, lymph nodes and peritoneal cavity. Metastasis to colon and anal canal are extremely rare. Aims To descripe a rare presentation of Pancreatobiliary cancer which need a high index of suspicion to diagnose and treat early. Methods A 65-year-old with multiple co-morbidities, who was initially referred to Gastroenterology team for evaluation for GI bleed associated with significant weight loss. He underwent an upper and lower scope, which revealed only mild radiation proctitis.He had abdominal CT, which showed portal vein thrombosis and to further evaluate this clot he underwent endoscopic ultrasound (EUS) which did not reveal any evidence of cancer. However. It only showed that the main pancreatic duct in the body was slightly dilated. His Alkaline Phosphatase and glutamytransferase were elevated. For further evaluation of his abnormal liver profile and weight loss, MRCP was ordered but it returned back normal. Few months latter, he presented to the emergency department with weakness and bright red bleeding per rectum. He was diagnosed with left MCA stroke and admitted to ICU. Interestingly, his LFTs results showed significant increase,specifically ALP and GGT levels, from his baseline. Flexible Sigmoidoscopy was done to further evaluate his lower GI bleed and it showed again an evidence of radiation proctitis but this time multiple biopsies were taken from the rectum. His rectal biopsy showed: Atypical glandular structures straddling the muscularis mucosa highly suggestive for malignancy from pancreatcobiliary tree. He had full work up for his elevated ALP including AMA, which was negative. CA 199 was ordered and the result was extremely high >10000 units/ml(rest of the tumor markers including CEA and AFP were unremarkable). Looking at the full picture including his presentation with weight loss, finding on his rectal biopsy and elevated CA19-9 fulfill the diagnosis of metastatic pancreatobiliary cancer, most likely infiltrative cholangiocarcinoma. Results Diagnosis of pancreatobiliary cancer based on extremely elevated CA19-9 and rectal metastasis. Conclusions Based on the literature, a small number of colon metastases have been reported to occur in relation to cholangiocarcinomas(only 4 cases)and pancreatic adenocarcinomas(only 3 cases).In fact, the rectal metastasis wasn’t described in the lite