Needle tract seeding following endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer: a report of two cases

Abstract

Background Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a useful tool in pancreatic cancer diagnosis. However, the procedure itself may cause peritoneal dissemination and needle tract seeding at the puncture site. We herein report two cases of gastric wall metastasis due to needle tract seeding after EUS-FNA. Case presentation Case 1: A 68-year-old woman was admitted to our hospital for persistent cough. Computed tomography (CT) scan revealed inflammatory changes in the left lung field, and incidentally, a 15-mm hypovascular mass was detected in the pancreatic body. She underwent EUS-FNA and was diagnosed as pancreatic adenocarcinoma. She underwent distal pancreatectomy with splenectomy; however, a small hard mass was observed in the posterior gastric wall during surgery. We performed partial gastrectomy, and the resected specimen was diagnosed as a needle tract seeding following EUS-FNA. She then underwent adjuvant chemotherapy with TS-1, but the pancreatic cancer showed recurrence 6 months after surgery. She died due to peritoneal dissemination 18 months after surgery. Case 2: A 70-year-old man was incidentally detected with a pancreatic body mass on a CT scan as part of his follow-up for recurrence of basal cell carcinoma. He underwent EUS-FNA and was diagnosed as pancreatic adenocarcinoma. He had nodules in both lungs, and it was difficult to differentiate them from lung metastasis of pancreatic cancer. Therefore, he underwent neoadjuvant chemoradiotherapy, and thereafter, the lung nodules showed no changes; hence, he underwent distal pancreatectomy with splenectomy. During surgery, we observed a hard mass in the posterior gastric wall. We performed partial gastrectomy, and the resected specimen was diagnosed as needle tract seeding due to EUS-FNA. He underwent chemotherapy with TS-1, and he is still alive 18 months after surgery at the time of writing. Conclusion For resectable pancreatic body or tail tumors, EUS-FNA should be carefully performed to prevent needle tract seeding and intraoperative as well as postoperative assessment for gastric wall metastasis is mandatory.

Impact of Fiducial Marker Placement Before Stereotactic Body Radiation Therapy on Clinical Outcomes in Patients With Pancreatic Cancer

“…Recent reports have suggested that fiducial placement carries some risk of morbidity, such as the potential for needle track seeding by extrapolating cases reported from EUS FNA of the pancreas or pancreatitis (13,14).…”

“…However, placing a fiducial carries some risk. This additional procedure carries a very small risk of pancreatitis and may result in tumor seeding along the needle track (13,14). Moreover, systems that do not rely on fiducials such as magnetic resonance linear accelerators (MR Linac) or CT-on-rails have shown that high-quality SBRT can be done without fiducial markers (15)(16)(17).…”

Overlooked risk for needle tract seeding following endoscopic ultrasound-guided minimally invasive tissue acquisition

“…Since the first described case of EUS-FNA-induced needle tract seeding in a patient with intraductal papillary mucinous neoplasm in 2003[ 45 ], 33 patients with needle tract seeding following EUS-FNA or EUS-FNB have been reported up to January 2020. Of these cases, 27 were found in pancreatic cancer patients after EUS-FNA[ 19 , 20 , 25 , 27 , 28 , 36 , 40 , 46 - 58 ], one in a pancreatic cancer patient after EUS-FNB[ 34 ] (Table 1 ), and five in patients with other intra-abdominal and intrathoracic tumors after EUS-FNA[ 59 - 63 ] (Table 2 ). A total of 29 cases with pancreatic body or pancreatic tail cancer had needle tract seeding caused by diagnostic FNA or FNB.…”

Needle tract seeding recurrence of pancreatic cancer in the gastric wall with paragastric lymph node metastasis after endoscopic ultrasound-guided fine needle aspiration followed by pancreatectomy: a case report and literature review

“…To the best of our knowledge, this is the first report of a gastric submucosal tumor arising from needle tract seeding along with paragastric lymph node metastasis. Since the first case was reported by Hirooka et al in 2003, a total of 18 cases including the present case have been described, and 13 cases were reported within the last 5 years (Table 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Among these cases, there was no pancreatic tumor located in the head of the pancreas.…”