HEMATOGENOUS METASTASES OF PANCREATIC DUCTAL CARCINOMA

To investigate the heterogeneity of hematogenous metastases of pancrea tic ductal carcinomas, we investigated carcinomatous spread in 130 aut opsy cases. Hepatic metastases occurred most frequently, in 81 cases ( 62%), which may be explained by the fact that all veins draining the p ancreas flow into the portal system. We closely examined the 49 cases without hepatic metastases, Sixteen patients had pulmonary metastases without hepatic metastases, whereas seven had peculiar hematogenous me tastases without hepatic or pulmonary metastases, Fifteen of these 23 patients had pancreatic body carcinomas. The unusual patterns of sprea d might be due to (a) hepatofugal portosystemic shunting induced by sp lenic vein obstruction, (b) retrograde lymphatic infiltration from met astatic tracheobronchial lymph nodes, or (c) aggressive characteristic s of the tumors indicated by peculiar histologic features such as pleo morphic or mucoepidermoid carcinoma, etc. Sixteen patients showed only lymph node metastases and 10 had no distant metastases. Seventeen of these 26 cases had pancreatic head carcinoma. Histologically, two pati ents had mucinous cystadenocarcinomas, and six had adenocarcinomas pro ducing rich mucin. The average age of the group with no distant metast ases was higher.