CUTANEOUS METASTASIS OF PANCREATIC CARCINOMA AS AN INITIAL SYMPTOM IN THE LOWER EXTREMITY WITH OBSTRUCTIVE LYMPHEDEMA TREATED BY PHYSIOTHERAPY AND LYMPHATICOVENOUS SHUNT: A CASE REPORT, REVIEW, AND PATHOPHYSIOLOGICAL IMPLICATIONS

Abstract

Cutaneous metastasis from pancreaticcancer is relatively rare as an initial symptom,and it is generally localized on the periumbilicalarea that is known as Sister MaryJoseph’s nodule. We report a rare case of a49-year-old female who developed cutaneousmetastasis of pancreatic cancer as an initialsymptom. The patient was referred to ourdepartment for treatment of lymphedema dueto surgical treatment of cervical cancer andunderwent combined physiotherapy and, 2months later, a lymph venous anastomosis(LVA) for treatment of the lymphedema. Twomonths after the operation, she developederythema on her right leg which spread fromthe leg to the groin in series. This patterncorresponded to the direction of lymphdrainage, which may have been enhanced bythe conservative physiotherapy and LVAtreatments. These facts suggest a possiblerelationship between cutaneous metastasis ofcarcinoma and treatment for lymphedema.Alternatively, the lymphedematous limb maybe a privileged site for cancer growth, andmetastatic seeding could have taken placefrom pre-existing hematogenous spread at thetime of operation.