Margin-negative limited resection of metastatic pancreatic tumors from rectal cancer preoperatively diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsies: report of two cases

Abstract

Pancreatic tumor metastasis from colorectal cancer is very rare. This study evaluated the significance of an endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) and surgical treatment. Case 1 was a 67-year-old male with a history of rectal cancer (6 years ago) and lung metastases (5 years ago) who had two masses in the pancreatic head and body. Case 2 was a 58-year-old male with the history of rectal cancer and simultaneous lung metastasis (7 years ago) who had a mass in the pancreatic body. Imaging studies showed stenosis of the pancreatic duct with distal dilatation in both cases, mimicking primary pancreatic cancer. An EUS-FNAB with immunohistochemical staining made a definitive diagnosis of pancreatic metastasis from rectal cancer. Both patients received margin-negative limited resection, middle-segment-preserving pancreatectomy and distal pancreatectomy, respectively, and were alive 16 and 6 months after pancreatectomy, respectively. An EUS-FNAB is helpful to make a definitive diagnosis of pancreatic metastasis and in determining the subsequent therapeutic approach.

Pancreatic Metastasis from Rectal Cancer that was Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Aspiration (EUS-FNA)

“…Twenty-eight patients presented with single pancreatic metastasis; in 9 cases additional surgery was required to treat metastatic disease in other sites. In some case reports on pancreatic metastasis from rectal cancer, a history of metachronous pulmonary metastasis prior to the diagnosis of pancreatic lesions was reported (3,4,16,17). Inagaki et al (3) suggested that pulmonary tumors may metastasize to the pancreas by hematogenous spread.…”

“…However, more recently, several reports have been published regarding the use of EUS-FNA in the diagnosis of pancreatic metastases (4,7-11). In the diagnosis of pancreatic metastases, the sensitivity, specificity, positive and negative predictive values, and the accuracy of the histological analysis of EUS-FNA specimens are reported to be 93.8%, 60%, 93.8%, 60%, and 89%, respectively (11).…”

“…With regard to pancreatic metastasis from colorectal cancer, solitary metastasis to the pancreas is less common than multiple metastases to other organs - metachronous metastases to both the lungs and the pancreas are rare (3,4). …”

“…However, recent reports have shown that endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a feasible and safe method for definitively diagnosing pancreatic metastases and for planning the therapeutic approach (6). Moreover, several reports have suggested the effectiveness of EUS-FNA in diagnosing pancreatic metastases from colorectal cancer (4,7-11). However, to the best of our knowledge, there are few reports on the histopathological and immunohistochemical findings.…”

Small amounts of tissue preserve pancreatic function

“…[23,29,30] In our current series, the major indications were metastatic tumors of the pancreas, including renal cell carcinoma (RCC), DFSP, and pheochromocytoma. The most common origin of pancreatic metastatic tumor reported in the literature is RCC; others include breast cancer, lung cancer, colonic cancer, and melanoma.…”