Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2006; 12(30): 4922-4926
Published online Aug 14, 2006. doi: 10.3748/wjg.v12.i30.4922
Obstructive jaundice caused by secondary pancreatic tumor from malignant solitary fibrous tumor of pleura: A case report
Norie Yamada, Chiaki Okuse, Masahito Nomoto, Mayu Orita, Yoshiki Katakura, Toshiya Ishii, Takuo Shinmyo, Hiroaki Osada, Ichiro Maeda, Hiroshi Yotsuyanagi, Michihiro Suzuki, Fumio Itoh
Norie Yamada, Chiaki Okuse, Masahito Nomoto, Mayu Orita, Yoshiki Katakura, Toshiya Ishii, Michihiro Suzuki, Fumio Itoh, Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan
Takuo Shinmyo, Hiroaki Osada, Department of Chest Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan
Ichiro Maeda, Department of Diagnostic Pathology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan
Hiroshi Yotsuyanagi, Division of Infectious Diseases, Department of Internal Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Chiaki Okuse, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki 216-8511, Japan. c2okuse@marianna-u.ac.jp
Telephone: +81-44-9778111 Fax: +81-44-9765805
Received: March 29, 2006
Revised: April 14, 2006
Accepted: April 24, 2006
Published online: August 14, 2006
Abstract

A 77-year-old man on systemic chemotherapy against postoperative bilateral multiple lung metastases of malignant solitary fibrous tumor of the pleura suffered from pruritus and jaundice. Blood examination showed elevated levels of hepatobiliary enzymes. Abdominal computed tomography showed a tumor with peripheral enhancement in the pancreatic head, accompanied with the dilatation of intra- and extra-hepatic bile ducts. He was diagnosed as having obstructive jaundice caused by a pancreatic head tumor. The pancreatic head tumor was presumably diagnosed as the metastasis of malignant solitary fibrous tumor of the pleura, because the findings on the pancreatic head tumor on abdominal CT were similar to those on the primary lung lesion of malignant solitary fibrous tumor of the pleura. The pancreatic tumor grew rapidly after the implantation of metallic stent in the inferior part of the common bile duct. The patient died of lymphangitis carcinomatosa of the lungs. Autopsy revealed a tumor that spread from the pancreatic head to the hepatic hilum. Microscopically, spindle-shaped cells exhibiting nuclear atypicality or division together with collagen deposition were observed. Immunohistochemically the pancreatic head tumor cells were negative for staining of α-smooth muscle actin (α-SMA) or CD117, but positive for vimentin, CD34 and CD99. These findings are consistent with those on malignant solitary fibrous tumor of the pleura. We report the first case of obstructive jaundice caused by a secondary pancreatic tumor from malignant solitary fibrous tumor of the pleura.

Keywords: Malignant solitary fibrous tumor of the pleura; Secondary pancreatic tumor; Obstructive jaundice