Rare Pancreatic Cancer Diagnosed in Patient With Kaposi Sarcoma
Clinicians from University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom, report a rare case of primary squamous cell carcinoma of the pancreas in a patient with Kaposi sarcoma, highlighting diagnostic complexity.
Primary squamous cell carcinoma of the pancreas represents one of the rarest malignant diseases of this organ and remains poorly understood. This is largely due to the fact that the pancreas normally does not contain squamous epithelial cells, making its origin unclear. As explained, proposed mechanisms include squamous metaplasia within the pancreatic ducts secondary to chronic inflammation, transformation of a pre-existing glandular tumour, or development from primitive cells capable of divergent differentiation.
A new case published this month describes a rare example of primary squamous cell carcinoma of the pancreas and highlights its diagnostic complexity. The authors of “Primary squamous cell carcinoma of pancreas in a patient with Kaposi sarcoma: A rare case report” are Shahid Gilani, Kanchana Wickramasinghe, Rani Pillai, and Ibrahim Khir.
The presented case highlights the complexity of diagnosis
“We report the case of an 83-year-old man with a background of HIV-negative Kaposi sarcoma (KS), previously treated with liposomal doxorubicin and paclitaxel, who was found to have an incidental pancreatic uncinate process mass on surveillance imaging,” the scientists wrote. During routine follow-up, and in the absence of clear pancreatic symptoms, a pancreatic mass was incidentally detected. At that stage, there was a reasonable suspicion that this represented progression of the known disease, although pancreatic involvement by Kaposi sarcoma is rare and typically associated with widespread disease.
Biopsy demonstrated the presence of squamous cells without glandular elements, while whole-body imaging did not identify another primary tumour. “Following review at the hepatopancreatobiliary multidisciplinary meeting, he was considered unsuitable for surgical resection because of his advanced age, frailty, and comorbidities.” Although the patient initially responded well to chemotherapy with gemcitabine and carboplatin, combined with radiotherapy, the disease later progressed, followed by a sudden clinical deterioration, including gastrointestinal bleeding.
The importance of multidisciplinary evaluation
As stated, a key issue in diagnosis is distinguishing primary squamous cell carcinoma of the pancreas from other possibilities. “Although this may represent a coincidental occurrence, it is notable that the patient had received prior systemic therapies, including liposomal doxorubicin and paclitaxel for KS. There was, however, no evidence to suggest treatment-related causation, and no established direct association between these therapies and primary pancreatic SCC,” they explained.
According to the report, this case emphasises the importance of multidisciplinary evaluation, tissue diagnosis, and awareness that a new pancreatic lesion in a patient with an established malignancy may represent a second primary tumour rather than metastatic disease.
