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Bone Metastasis as the Only Site of Disease in a Patient 7 Years Post Treatment for a Locally Advanced Pancreatic Adenocarcinoma

Ashley E Ray, Lukas Faltings, Stephen Machnicki, Anuj Goenka, Elana Opher, Jordan Steinberg, Fanni Ratzon, Amory V Novoselac

Context Pancreatic adenocarcinoma is one of the most challenging diseases to treat. Even patients able to undergo resection for potential cure have a high risk of recurrence and require close monitoring. The typical areas of recurrence and/or metastasis are the surgical bed, liver, and lungs. We present a rare case of a solitary bone metastasis identified seven years after a Whipple procedure for pancreatic adenocarcinoma. This is the first case report to demonstrate its ability to metastasize to bone in the absence of other systemic disease more than 7 years after surgical resection and adjuvant therapy. Case report The patient initially presented with a locally advanced pancreatic adenocarcinoma that was resected, pT3N1b. He was treated with 6 months of adjuvant chemotherapy, and monitored thereafter with quarterly MRI’s of the abdomen and pelvis, and the CA 19-9 tumor marker. The patient had a good performance status (KPS 100), with no evidence of recurrence until over 7 years later, when an elevation in his CA 19-9 triggered a systemic workup. An isolated sclerotic lesion in the right sacral ala was identified on imaging and biopsied, found to be adenocarcinoma, consistent with pancreaticobilliary origin. Conclusions This case highlights the unusual ability of pancreatic adenocarcinoma to recur many years after treatment. It also shows the potential for pancreatic adenocarcinoma to metastasize to the bone as a solitary lesion and illustrates the role of CA 19-9 in monitoring tumor recurrence and treatment response. As patients may live longer with the recent advances in chemotherapy, this report may help inform providers about possible unusual patterns of recurrence.