Endoscopic ultrasound-guided fine-needle aspiration diagnosis of secondary tumors involving the pancreas: An institution's experience

Abstract

Background:Pancreatic masses may seldom represent a metastasis or secondary involvement by lymphoproliferative disorders. Recognition of this uncommon occurrence may help render an accurate diagnosis and avoid diagnostic pitfalls during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). In this study, we review our experience in diagnosing secondary tumors involving the pancreas.Materials and Methods:The electronic database of cytopathology archives was searched for cases of secondary tumors involving the pancreas at our institution and a total of 31 cases were identified. The corresponding clinical presentations, imaging study findings, cytological diagnoses, the results of ancillary studies, and surgical follow-up, if available, were reviewed.Results:Nineteen of the patients were male and 12 female, with a mean age of 66 years. Twenty-three patients (74%) had a prior history of malignancy, with the latency ranging from 6 months to 19 years. The secondary tumors involving the pancreas included metastatic carcinoma (24 cases), metastatic sarcoma (3 cases), diffuse large B-cell lymphoma (2 cases), and plasma cell neoplasm (2 cases). The most common metastatic tumors were renal cell carcinoma (8 cases) and lung carcinoma (7 cases). Correct diagnoses were rendered in 29 cases (94%). The remaining two cases were misclassified as primary pancreatic carcinoma. In both cases, the patients had no known history of malignancy, and no ancillary studies were performed.Conclusions:Secondary tumors involving the pancreas can be accurately diagnosed by EUS-FNA. Recognizing uncommon cytomorphologic features, knowing prior history of malignancy, and performing ancillary studies are the keys to improve diagnostic performance and avoid diagnostic pitfalls.

Falling under the umbrella cells: A single institutional experience and literature review of urothelial carcinoma presenting as a primary pancreatic mass on endoscopic ultrasound-guided fine-needle aspiration

“…[910] As stated above, it is very unusual for UC to metastasize to the pancreas, with only rare reports diagnosed by FNA in the literature in addition to those we reported [Table 1]. Canter et al .…”

“…also only described one case of UC that had metastasized to the pancreas between 2005 and 2012, out of the 1346 patients who had undergone EUS-FNA with ROSE for pancreatic lesions at Yale University. [10] This patient was a 69-year-old female who apparently had a known prior history of malignancy and previous bladder resection and presented with a solitary lesion of the pancreatic body after a 2-year latent period. Due to prior resection, this patient had histological evidence of the primary malignancy which confirmed the cytological diagnosis, so no ancillary studies were performed.…”

Metastatic neoplasms to the pancreas diagnosed by fine‐needle aspiration/biopsy cytology: A 15‐year retrospective analysis

“…Sixteen studies of series of pancreatic metastases diagnosed by FNA/CNB were reported between 1992 and 2016 (Table ). The study durations were 2–26 years and included 112–5495 pancreatic FNA/CNB . Only 11–66 metastases were detected in these reports, comprising only 0.7%‐11.1% of all FNA/CNB and 1.8%‐10.8% of all neoplasms.…”

“…Endoscopic ultrasound (EUS) guided FNA is a minimally invasive procedure which reduces associated hemorrhage and potential infection, as a result of direct visualization and sampling of smaller amounts of tissue . Additionally, EUS‐guided FNA proffers high accuracy, and the ability to detect lesions smaller than 1 cm . With the advent and increased utilization of EUS, we have observed the diminution of computerized tomographic (CT) guided pancreas biopsies in our institution.…”

“…Metastasis to the pancreas is not a common occurrence, with its incidence in fine‐needle aspiration (FNA) series ranging from 0.7% to 11.1% of all FNAs and 1.8% to 10.8% of all pancreatic cancers . In the setting of metastatic disease, it is clearly desirable to confirm the pathologic diagnosis by a less invasive diagnostic modality.…”