Pancreatic involvement by metastasizing neoplasms as determined by endoscopic ultrasound-guided fine needle aspiration: A clinicopathologic characterization

Solitary Pancreatic Metastasis from an Ovarian Carcinoma: A Diagnostic Perplexity

Ovarian cancer presenting as an isolated pancreatic metastasis after years of treatment is extremely rare. Most such patients are easily misdiagnosed as a case of primary pancreatic cancer. We herein describe a unique case of posttreatment high-grade serous papillary ovarian carcinoma metastasizing to the pancreas that mimicked primary pancreatic cancer and caused a diagnostic dilemma. The approach to such a case, pathogenesis, differential diagnosis, management, and a brief literature review is also presented.

Metastases to pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration: A case series and review of imaging and cytologic features

Fine-needle aspiration (FNA) is ideal for the diagnosis of pancreatic neoplasms with high precision. We described five cases of metastases to the pancreas, highlighting the importance of clinical data, imaging features and the use of immunocytochemistry to lead the diagnosis. We retrospectively searched our archives for metastatic neoplasm to the pancreas diagnosed with FNA performed with endoscopic ultrasound, over a 5-year period. Furthermore, we reviewed the literature for imaging and cytologic features. We described five cases of metastatic neoplasms, a renal cell carcinoma, a breast carcinoma, one leiomyosarcoma, a hepatocellular carcinoma, and ovarian serous carcinoma. All of them has history of primary malignancy and were confirmed with immunostains. All the patients were asymptomatic and identified the metastasis during the follow-up, except for the ovarian serous carcinoma were the patient had acute abdominal pain, and the most common imaging feature were the irregular borders. Although the metastases to pancreas are rare, its important to always have the history of the patient, imaging features, and the suspicion at the moment of the evaluation of the smears and cell-block, because the management and prognostic its different compared to primary malignancies.

Comments on and Illustrations of the EFSUMB CEUS Guidelines: Transabdominal and Endoscopic Ultrasound Features of Intrapancreatic Metastases and the Role of Multiparametric Imaging and EUS-Guided Sampling in Rare Pancreatic Tumors

A definite pathologic diagnosis of intrapancreatic metastasis is crucial for the management decision, i.e., curative or palliative surgery versus chemotherapy or conservative/palliative therapy. This review focuses on the appearance of intrapancreatic metastases on native and contrast-enhanced transabdominal ultrasound and endoscopic ultrasound. Differences and similarities in relation to the primary tumor, and the differential diagnosis from pancreatic carcinoma and neuroendocrine neoplasms are described. The frequency of intrapancreatic metastases in autopsy studies and surgical resection studies will be discussed. Further emphasis is placed on endoscopic ultrasound-guided sampling to confirm the diagnosis.

Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Diagnosis of Pancreatic Metastases Secondary to Ovarian Carcinoma

Pancreatic metastases from ovarian carcinoma are rare. We present a case of a patient with pancreatic metastasis from primary ovarian carcinoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Our case illustrates a unique presentation of a patient with ovarian carcinoma presenting with symptoms secondary to common bile duct dilatation from a pancreatic head mass confirmed through a much less invasive approach. This diagnosis was essential in determining management and prognosis for the patient.

Solid Tumor Metastases to the Pancreas Diagnosed Using Fine-Needle Aspiration

OBJECTIVES

Solid tumor metastases to the pancreas are rare, and only limited literature on the topic is available. In this retrospective study, we reviewed 107 cases of solid tumor metastases to the pancreas diagnosed by fine-needle aspiration (FNA) from 2005 to 2019.

METHODS

Information including the patients' clinical histories, radiologic and pathologic findings, treatments, and follow-up were collected.

RESULTS

The mean age of the patients was 62.4 years. The mean tumor size was 2.64 cm with even distribution throughout the pancreas (head, neck and body, and tail). The most common primary site was the kidney, followed by the lung, skin, and breast and the gynecologic, gastrointestinal, and genitourinary tracts. The most common tumor type was carcinoma, followed by melanoma and sarcoma. In comparison to patients with nonkidney primary cancers, those with primary renal cell carcinoma had a longer median interval between primary diagnosis and metastasis (8.5 vs 4.0 years; P < .01), less often had metastasis outside the pancreas (38% vs 74%; P < .01), and had a significantly longer 5-year survival rate (65.7% vs 24.8%; P < .01).

CONCLUSIONS

FNA plays a crucial role in diagnosing metastases to the pancreas. Metastases originating from kidney and nonkidney primary tumors have distinct clinicopathologic features and prognoses.

Diagnosis and Treatment of Metastatic Disease to the Pancreas

Introduction: Metastatic disease to the pancreas is a rare entity from all malignant pancreatic masses. Its diagnosis is very challenging, but with the introduction of endoscopic ultrasound (EUS)-fine needle aspiration (FNA), now there is a feasible way to make an accurate histopathological and definitive diagnosis. Materials and Methods: This is a retrospective review of 11 patients with metastasis to the pancreas diagnosed with EUS-FNA in a tertiary referral center over a period of 3 years. We describe our institutional experience in diagnosing metastatic disease to the pancreas through EUS-FNA. Results: Between January 2015 and June 2018, 115 patients were diagnosed with pancreatic malignancy by EUS-FNA and only 11 (10%) with metastatic disease to the pancreas. Most common primary malignancy was renal cell carcinoma, followed by colon carcinoma, squamous/small cell carcinoma of the lung, and urothelial carcinoma. Five of 11 patients presented as a solitary pancreatic mass on initial imaging without any evidence of primary or metastatic disease elsewhere. Conclusions: In our experience, metastatic disease to the pancreas can represent up to 10% of solid pancreatic masses, which is lower compared to the reported incidence in previous literature. Our findings reveal that early identification and diagnosis help patient management and limit surgical morbidity and mortality.

Evaluation of metastases to the pancreas with fine needle aspiration: A case series from a single centre with review of the literature

OBJECTIVE

Fine needle aspiration (FNA) is a minimally invasive albeit highly effective modality used to detect solid and cystic pancreatic lesions. This manuscript aims to present our experience in diagnosing metastases to the pancreas and highlight the importance of immunocytochemistry in the diagnostic process. It also aims to provide a brief review of the literature on this topic.

METHODS

We retrospectively searched our archives for cases of metastatic deposits to the pancreas diagnosed with FNA over a 5-year period. We also reviewed the literature for such cases.

RESULTS

We describe seven cases from our archives that metastasised to the pancreas. Three of them (43%) represented metastatic renal cell carcinoma while the rest four comprised deposits from a lung adenocarcinoma, a colon adenocarcinoma, an adrenal leiomyosarcoma, and a small cell carcinoma of the urinary bladder, respectively. History of primary malignancy was available for all seven patients. All diagnoses were confirmed with the use of immunostains. In our literature review, similar to our case series, renal cell carcinoma was the most common metastasis to the pancreas managed with FNA (around one out of three patients; 35%). Of interest, our endoscopic ultrasound-FNA case of pancreatic metastasis from urinary bladder small cell carcinoma is the first reported.

CONCLUSIONS

As metastases to the pancreas are commonly accompanied by diverse prognostic signatures and management strategies compared to primary pancreatic malignancies, their accurate identification is imperative. Pancreatic FNA is a diagnostic modality that can confirm or exclude metastasis to the organ, especially when immunocytochemistry is applied.

[Metastatic renal cell carcinoma to the pancreas: experience of surgical treatment]

OBJECTIVE

To evaluate the outcomes in patients undergoing surgery for metastatic renal cell carcinoma (RCC) to the pancreas.

MATERIAL AND METHODS

A retrospective analysis included 54 patients with pancreatic metastases (PM) of RCC who underwent surgical treatment at the Blokhin National Cancer Medical Research Center and Vishnevsky National Medical Research Center of Surgery in 1995-2018. PM were synchronous in 6 (11%) patients and metachronous in 48 (89%) patients. Solitary metastases were identified in 35 (65%), single metastases - in 14 (26%), multiple metastases - in 5 (9%) patients. Thirty (56%) patients had isolated PM, 24 (44%) patients - PM associated with another metastatic site. The following surgical procedures were performed: distal pancreatectomy (n=30, 55%), pancreatoduodenectomy (n=12, 21%), total pancreatectomy (n=6, 12%), pancreatic head resection (n=3, 6%), middle-preserving pancreatectomy (n=1, 2%), middle pancreatectomy (n=1, 2%), cryosurgical destruction of tumor (n=1, 2%).

RESULTS

Median blood loss was 950 ml (interquartile range 400-1800 ml). Postoperative complications occurred in 52% patients. The 90-day mortality rate was 6%, overall 5-year survival 74±7%, median - 84 months.

CONCLUSION

Surgery is associated with an acceptable perioperative complications and long-term survival in patients with synchronous and metachronous, solitary and multiple PM of RCC, including cases of extrapancreatic disease. This approach may be considered as a management option in these patients.

Diagnostic utility of immunohistochemical analysis and Epstein-Barr virus-encoded small RNAs in situ hybridisation of cell block sections obtained using fine-needle aspiration in nasopharyngeal carcinoma with lymph node metastasis

OBJECTIVE

This study aimed to investigate the diagnostic utility of immunohistochemistry (IHC) analysis (FNA) and Epstein-Barr virus- (EBV) encoded small RNAs (EBERs) in situ hybridisation analyses of cell block (CB) sections obtained using fine needle aspiration in nasopharyngeal carcinoma (NPC) with lymph node metastasis.

METHODS

A total of 38 FNA biopsies were collected using a Youyi aspirator. The cytomorphology, CB-based histomorphology, IHC, and EBERs in situ hybridisation were observed and the sensitivity/final diagnostic rates were compared with those of simple smears and a combination of smears and CBs.

RESULTS

The 38 cases of metastatic lymph nodes from NPC displayed the morphological characteristics of non-keratinising carcinoma in cell smears and CB sections. The tumour cells showed high expression of CK5/6, P63, Ki-67, and EBERs (94.7%, 36/38 cases) in the CB sections. The sensitivity and the final diagnostic rates were lowest with the simple cell smears (86.8%, 33/38 and 71.1%, 27/38 cases), moderate with the smears combined with CB sections (92.1%, 35/38 cases and 81.6%, 31/38 cases), and the highest with IHC and EBERs in situ hybridisation (94.7%, 36/38 and 94.7%, 36/38 cases).

CONCLUSIONS

FNA has great value in the diagnosis of NPC with lymph node metastases, and using cell smears combined with IHC and EBERs in situ hybridisation of CB sections could help clinical doctors promptly identify the primary lesions.

An Unusual Case of Pancreatic Metastasis from Squamous Cell Carcinoma of the Lung Diagnosed by EUS-Guided Fine Needle Biopsy

We report a case of a 70-year-old man who presented with abdominal pain and weight loss, with initial imaging showing simultaneous mass lesions in the pancreas and lungs along with extensive lymphadenopathy in the thorax up to the left supraclavicular region. Core biopsies of the left supraclavicular lymph node showed squamous cell carcinoma, which required differentiation between secondary and primary pancreatic neoplasms. Endoscopic ultrasound-guided sampling using a novel fine needle biopsy system was key to making a definite histological diagnosis and determining the best treatment plan.