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9 In 2010, an estimated 43,000 Americans will be diagnosed with pancreatic cancer, with 18,700 people succumbing to the disease.9 Given the absence of early signs or symptoms of pancreatic cancer, 65% to 70% of all patients will have nodal or distant metastases to the liver, lungs, or bone at the time of diagnosis.1 Despite this fact, pancreatic cancer metastases to the brain are exceedingly rare (0.33% of pancreatic adenocarcinoma cases), perhaps owing to the aggressive nature of pancreatic adenocarcinoma and the fact that most patients do not survive long enough to experience clinical manifestations of brain metastasis.27 http://www.selleck.cn/products/gsk126.html However, recent advances in the detection and treatment of pancreatic adenocarcinoma have resulted in prolonged survival and an increased incidence of brain metastasis.28 Kuratsu et al28 reported 2 patients with pancreatic adenocarcinoma with a mean bDFI of 10 months and mean overall survival of 19 weeks following diagnosis of brain metastasis. Demchuk et al29 was the first to report an antemortem diagnosis of brain metastasis in a patient with pancreatic adenocarcinoma. Since then, only 8 cases of pancreatic adenocarcinoma with antemortem metastasis to the brain (1 retrospective study, 4 case reports) have been reported in the English literature (Table 4). The bDFI ranged from 5 to 24 months among these patients and survival ranged from 2 weeks to >16 months after diagnosis of brain metastasis (Table 4).27, 28, 30 In a retrospective analysis of 1229 pancreatic http://www.selleckchem.com/products/BI-2536.html adenocarcinoma patients treated at Seoul National University Hospital between 1980 and 2000, Park et al27 reported only 4 patients (0.33%) with metastasis to the brain. Although all 4 patients had concurrent metastasis to the lung, liver, and/or bone, neurologic symptoms was the first manifestation of pancreatic cancer in 2 patients. The bDFI was 4.5 �� 0.7 months (P http://www.selleckchem.com/products/Cyclopamine.html et al30 reported on a patient who presented with intractable vomiting 2 years after diagnosis and treatment of pancreatic adenocarcinoma. These symptoms were initially attributed to peritoneal carcinomatosis but was later confirmed by magnetic resonance imaging (MRI) to be a brain metastasis. The authors concluded that, although vomiting in a patient with pancreatic adenocarcinoma usually suggests intra-abdominal local recurrence, metastases, or peritoneal carcinomatosis, neuroimaging is indicated if an intra-abdominal explanation for vomiting is not found.