Surgical Science, 2013, 4, 506-508
Published Online November 2013 (http://www.scirp.org/journal/ss)
Open Access SS
Pancreaticodu odenectomy for Pancreatic Metastases of
Malignant Fibrous Histiocytoma*
Jing Zhu, Huihua Cai#, Donglin Sun
Department of Hepatobiliary Surgery, The First People’s Hospital of Changzhou, Soochow University,
Received October 7, 2013; revised November 5, 2013; accepted November 13, 2013
Copyright © 2013 Jing Zhu et al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Unlike primary pancreatic carcinoma, metastases to the pancreas are rare and their resection may be performed as a
palliative treatment due to poorly defined outcome. We herein present an extremely rare case of pancreatic metastases
of malignant fibrous histiocytoma (MFH) undergoing pancreaticoduodenectomy with tumor-free survival within post-
operative 35-month follow-up. Pancreatic resection for metastatic MFH to the pancreas should be considered in selected
patients. Long-term survival or good palliation may be achieved.
Keywords: Pancreaticoduodenectomy; Pancreatic Metastasis; Malignant Fibro us Histiocytoma
The pancreas has been found to be a rare site of metasta-
sis with malignant tumor; the kidney, breast, lung, colon,
and skin are the most common sites of the primary tumor
. So the quantity of literatures of pancreatic metasta-
sis (PM) of malignant fibrous histiocytoma (MFH) is
very limited and only a few cases have been reported in
the world till now [2-5]. In this repo rt we will describe a
patient suffering from isolated pancreatic metastasis of
MFH, and the clinical features of the treatme nt. The out-
comes are also discussed.
2. Case Report
The patient was a 69-year-old male. His past medical
history showed that he had undergone lumpectomy in the
left back at anoth er hospital in May 2006, and MFH was
diagnosed by pathologic examination. Unfortunately, he
suffered from another two radical operation because of
local recurrence on June 21, 2006 and October 31, 2006
respectively. Local radiotherapy was followed by the
third operation and relapse was no longer found in the
He was admitted to our hospital on October 8, 2008
because of expectorated blood-tinged sputum intermit-
tently for a month. Lower left lung mass was prompted
by chest radiography and CT. The left lower pulmonary
lobectomy was performed on October 13 and postopera-
tive pathology indicated metastatic MFH (Figure 1).
Three courses of CAP (CTX/ADM/DDP) regimen
chemotherapy were additionally treated after pulmonary
lobectomy and the regular re-examination prompted a
stable condition un til June 2010. He presen ted abdominal
pain for three days and CT indicated a tumor in the head
of the pancreas. The values of serum CEA, CA 19-9, CA
15-3 were within normal laboratory range. Without con-
traindications, pancreaticoduodenectomy was performed
on June 28, 2010, and metastatic malignant fibrous his-
tiocytoma of the head of the pancreas was proved by pos-
toperative pathology (Figure 1). The patient recovered
from the operations without complications and has been
remaining free of tumor in follow-up 35 months (Figure
Unlike primary pancreatic carcinoma, metastatic lesions
to the pancreas are rare, accounting for less than 5% of
all pancreatic neoplasms  and approximately 2% of
pancreatic malignancies [1,7]. Patients with pancreatic
metastases are often asymptomatic and detected inciden-
tally or during follow-up investigations even several
*Competing interest: no benefits in any form have been received or will
be received from a commercial party related directly or indirectly to the
subject of this article.
J. ZHU ET AL. 507
Figure 1. The cell feature of our case was a pleomorphic cell
arranged in a storiform pattern. The areas of malignant
fibrous histiocytoma infiltrating the pulmonary and pan-
creatic tissue are shown. (H&E staining. Upper: pulmonary
metastasis of MFH; Down: pancreatic metastasis of MFH).
Figure 2. A computed tomography scan of the abdomen
showing the tumor in the head of the pancreas (Left). No
local recurrence or distant metastasis was noted during
follow-up of 29 months (Right).
years after the removal of the primary tumor. The pri-
mary tumors are most commonly located in kidney,
breast, lung, and colon cancers, or more rarely, gastric
cancer, melanoma, and sarcoma [1,8-10].
Malignant fibrous histiocytoma (MFH) has been re-
garded as one of the most common sarcoma tumors in
soft tissue since the introduction of the concept of facul-
tative fibroblasts by Ozzello et al.  in 1963. This tu-
mor has a high likelihood of metastasis and recurrence
and the most common sites of occurrence are the up-
per/lower limbs, trunk followed by the chest and retrop-
eritoneal cavity. But pancreatic metastasis secondary to
MFH of is extremely uncommon. Up to date, there are a
few sporadic cases reported, using a systematic Pub Med
However, it is still controversial whether the patients
with PM should take the surgical treatment or not. But
some recent literatures [12,13] suggest that patients with
isolated PM can benefit from surgery and pancreatic re-
section may achieve long-term survival or good pallia-
tion in selected cases. The surgical complications and
perioperat i ve mortality of PM have no obvious diffe rence
with that of pancreatic primary tumors. The following
criteria for the selection of patients for pancreatic metas-
tasectomy are suggested: 1) primary cancer types that are
associated with successful outcomes, 2) control of the
primary cancer site, 3) isolated metastases, 4) resectabil-
ity of the metastasis, 5) patient fitness to tolerate pancre-
Despite the poor radiation sensitivity of MFH, radio-
therapy is still the main means of adjuvant therapy to
control local recurrence . But the efficacy of chemo-
therapy is still controversial. Some researchers contended
that concurrent adjuvant chemotherapy and radiotherapy
might be an effective treatment for MFH . However,
Gutierrez  suggested that surgical resection and ra-
diotherapy are unique among treatment modalities in
association with a significant su rvival benefit, rather than
In our experience, the patient underwent three local op-
erations in the left inferior back and pulmonary lobec-
tomy due to recurrence or metastasis from MFH. Resec-
tion of pulmonary metastases from sarcoma has been
studied extensively and can improve long-term survival.
In an independent study, the 5-year disease-free survival
in similar patients was reported to be 41% . Pancreas
solitary metastasis occurred in more than two years after
pulmonary resection. Solitary metastasis to the pancreas
occurs less frequently; in fact, there are few reports con-
cerning solitary resectable metastatic tumors of the pan-
creas. In the Mayo clinic series , only 27 out of 1357
patients (2%) with solitary pancreatic masses had secon-
dary pancreatic tumor, and only four of them were re-
sected. Pancreaticoduodenectomy was performed in our
patient successfully. He recovered from operation with-
out complications and remains free of tumor within 35-
month follow-up. Surgical resection has been regarded as
the best therapeutic option to improve the long-term sur-
vival of patients with isolated pancreatic metastasis. Ad-
juvant radiotherapy is still a helpful tool to control local
recurrence. The clinical effect of chemotherapy needs to
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