| Limited anatomic spread bypassing the liver and systemic dissemination |
Unusual lymphatic spread to lungs via tracheobronchial glands, via lymph nodes in venous triangle or portal venous collateral bypassing liver. Limited lymphatic spread to lungs via mediastinal lymph nodes without systemic dissemination. |
Kamisawa et al.8
Leach60
|
| Genetic heterogeneity and mutational subclones |
Geographically distinct mutational subclones capable of metastasizing to different organs including lungs. No consistent mutational pattern capable of pulmonary spread however found. Genetic heterogeneity between primary tumor and tumor cells in organ of secondary spread. |
Yachida et al.61
|
| Organ-specific driver mutations |
Pancreatic cancer cells harboring different organ specific driver mutations in different organs responsible for different prognosis. MYC and CCNE1 genes rearrangements/amplifications present in pulmonary metastasis but not in abdominal metastasis. |
Yachida et al.61
|
| Mutations in tumor suppressor genes |
Absence of mutations in CDK2NA and SMAD4 tumor-suppressor genes in subjects with isolated pulmonary metastases may be responsible for improved survival. Limited loss of SMAD4(DPC4) via somatic genetic inactivation in isolated pulmonary metastatic patients. Higher inactivation of this gene is associated with aggressive disease and poor prognosis. SMD4 loss is more prevalent in metastatic disease vs resectable. |
Vitellius et al.63
Arnaoutakis et al.28
Arnaoutakis et al.28
Embuscado et al.65
Tascilar et al.66
Blackford et al.68
|
