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Although the prognosis of PNET is better than that of pancreatic cancer [3, 4], some types of PNET, such as those presenting with multiple metastases at the initial diagnosis or with advanced locoregional diseases, are difficult to cure.
Radiation therapy is the most common treatment strategy since more than 70%% of the patients have multiple metastases at the time of diagnosis [ 5].
Two reports [ 10, 15] documented metastasis during postoperative follow-up after surgery: one was of liver metastasis at 7 months, while the other was of multiple metastases at 14 months.
The luciferase-expressing subclones of MDA-MB-231 characterized in this report also produced multiple metastases at high frequencies to clinically relevant tissues such as bone and brain following intracardiac injection of cells.
In contrast, the SC preconditioning of SW48 cells induced the development of multiple metastases at the lymph nodes, lung and peritoneum in the SC+ORT group, a highly significant difference for each metastatic site (P<0.05, Table 2).
Even though the cytologic examination test did not observe any malignant cells, the clinical diagnosis is cervical cancer with abdominal lymphadenopathy and multiple metastases at pleural and peritoneal region.
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Our case differs from the typical scenario: (1) It was diagnosed in an old patient and had an aggressive course, and (2) multiple metastases were present at the time of surgery.
When multiple metastases are found at the time of clinical diagnosis, surgical operations are usually not performed, and the patients are treated mainly by radiotherapy or chemotherapy with various anticancer drugs.
The presence of multiple metastases was also carefully recorded at the time of diagnosis of the first metastases as well as after the complete follow-up.
For bone metastases, if multiple metastases can be imaged and localized at the same time, they can be treated at the same time, otherwise, they can be treated on alternate days.
In the subgroup of patients with multiple metastases, 95% (19 out of 20) presented at least one metastasis positive for STMN1.
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