Metastatic pancreatic adenocarcinoma presenting as an occipital haemorrhage

Improving differentiation of hemorrhagic brain metastases from non-neoplastic hematomas using radiomics and clinical feature fusion

OBJECTIVES

This study aimed to develop and validate a fusion model combining multi-sequence MRI radiomics and clinico-radiological features to distinguish hemorrhagic brain metastasis covered by hematoma (HBM.cbh) from non-neoplastic intracranial hematomas (nn-ICH).

METHODS

The data of 146 patients with pathologically or clinically proven HBM.cbh (n = 55) and nn-ICH (n = 91) were collected from two clinical institutions. Radiomics features were extracted from various regions (hemorrhage and/or edema) based on T2-weighted, T1-weighted, fluid-attenuated inversion-recovery, and T1 contrast-enhanced imaging. Synthetic minority over-sampling technique (SMOTE) was performed to balance the minority group (HBM.cbh). Logistic regression (LR) and k-nearest neighbors (KNN) were utilized to construct the models based on clinico-radiological factors (clinical model), radiomic features from various modalities of MRI (radiomics model), and their combination (fusion model). The area under the curve (AUC) values of different models on the external dataset were compared using DeLong's test.

RESULTS

The 4-sequence radiomics model based on the entire region performed the best in all radiomics models, with or without SMOTE, where the AUCs were 0.83 and 0.84, respectively. The AUC of clinical mode was 0.71 with SMOTE, and 0.62 without SMOTE. The fusion model demonstrated excellent predictive value with or without SMOTE (AUC: 0.93 and 0.90, respectively), outperforming both the radiomics and clinical model (0.93 vs. 0.83, 0.71, p < 0.05 and 0.90 vs. 0.84, 0.62, p < 0.05, respectively).

CONCLUSIONS

The multi-sequence radiomics model is an effective method for differentiating HBM.cbh from nn-ICH. It can yield the best diagnostic performance prediction model when combined with clinico-radiological features.

Clinical and molecular characteristics of patients with brain metastasis secondary to pancreatic ductal adenocarcinoma

BACKGROUND

The prognosis for patients with pancreatic ductal adenocarcinoma (PDAC) is poor. Secondary brain metastasis (Br-M) occurs in less than 1% of patients. Clinical characteristics and molecular alterations have not been characterized in this rare patients' subset.

MATERIALS AND METHODS

The Foundry software platform was used to retrospectively query electronic health records for patients with Br-M secondary to PDAC from 2005 to 2023; clinical, molecular, and overall survival (OS) data were analyzed.

RESULTS

Br-M was diagnosed in 44 patients with PDAC. Median follow-up was 78 months; median OS from initial PDAC diagnosis was 47 months. Median duration from PDAC diagnosis to Br-M detection was 24 months; median OS from Br-M diagnosis was 3 months. At Br-M diagnosis, 82% (n = 36) of patients had elevated CA19-9. Lung was the most common preexisting metastatic location (71%) with Br-M, followed by liver (66%). Br-M were most frequently observed in the frontal lobe (34%, n = 15), cerebellar region (23%, n = 10), and leptomeninges (18%, n = 8). KRAS mutations were detected in 94.1% (n = 16) of patients who had molecular data available (n = 17) with KRASG12V being the most frequent subtype 47% (n = 8); KRASG12D in 29% (n = 5); KRASG12R in 18% (n = 3). Patients who underwent Br-M surgical resection (n = 5) had median OS of 8.6 months, while median OS following stereotactic radiosurgery only (n = 11) or whole-brain radiation only (n = 20) was 3.3 and 2.8 months, respectively.

CONCLUSION

Br-M is a late PDAC complication, resulting in an extremely poor prognosis especially in leptomeningeal disease. KRAS was mutated in 94.1% of the patients and the KRASG12V subtype was prevalent.

Pancreatic adenocarcinoma with brain metastases

Brain metastases are rare for patients with pancreatic adenocarcinoma. The incidence of brain metastasis may increase as improved systemic treatment regimens improve overall survival. Given the low incidence of brain metastasis, recognition of disease and management remain a challenge. We report three cases of metastatic pancreatic adenocarcinoma with brain metastases, review the literature and discuss its management principles.

Late metachronous cerebral metastasis of pancreatic adenocarcinoma of the tail of the pancreas: a case report

Background

Pancreatic cancer is one of the leading causes of cancer mortality and one of the most lethal malignant neoplasms worldwide. It is known for its local tumor extension to the liver; other common sites include the lung, distant lymph nodes, and bone. Brain metastases are extremely rare and represent less than 0.6% of all brain metastases.

Case report

We report the case of a 66-year-old Caucasian female known to have adenocarcinoma of the tail of the pancreas treated with chemotherapy. During follow-up, thoracoabdominal computed tomography scans did not reveal any residual tumor or any metastasis. Moreover, tumor markers were within normal limits. She presented to the emergency department of our institution following an episode of a generalized tonic–clonic seizure 5 years following the initial diagnosis. Brain magnetic resonance imaging revealed an expansive left frontal intraaxial lesion compatible with high-grade glioma. The patient underwent surgical treatment. Histological examination revealed pancreatic metastasis.

Conclusions

Thought to be rare, metachronous cerebral pancreatic metastasis should be kept in mind in patients with pancreatic cancer. Early diagnosis and complete surgical resection play a key role in the survival of these patients.