Pancreatic metastasis from non-small-cell lung cancer diagnosed using endoscopic ultrasound-guided fine needle aspiration biopsy: A case report

Abstract

INTRODUCTIONPancreatic metastasis from the lungs is rare and accounts for less than 5% of pancreatic malignancies that are not detected on autopsy (1). The most common indication for pancreatic metastasectomy is spread from renal cell carcinoma (RCC), whereas the most common metastatic sites of lung cancer are the adrenal glands, liver, brain, and bones (2,3). A previous systematic review identified only 27 publications with data from 32 patients who underwent pancreatic metastasectomy for metastases from lung cancer (4). Therefore, detection of metastatic lung cancer to the pancreas is relatively rare in a living patient (i.e., not on autopsy). Furthermore, detection of small pancreatic tumors and differentiating between malignant and benign etiologies are difficult. Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) is a useful modality to improve the diagnosis of pancreatic tumors and to guide the treatment plan (5). In this study, we described a rare case of pancreatic metastasis from non-small-cell lung cancer (NSCLC) that was diagnosed using EUS-FNAB. CASE PRESENTATIONA 56-year-old man with a smoking history of 42 packyears underwent regular follow-up computed tomography (CT) scans for adult-onset type II citrullinemia and idiopathic pulmonary fibrosis. In 2015, CT scan revealed a right upper lobe nodule measuring 31 mm in diameter; no mass was observed in the pancreas (Figure 1). Bronchoscopy was performed, and he was diagnosed with adenocarcinoma using brush cytology. Positron emission tomography/CT (PET/CT) showed high fluorodeoxyglucose uptake in the right upper lobe nodule and no abnormal uptake in the hilar and mediastinal lymph nodes, as well as in other organs, including the pancreas (Figure 2).Based on a clinical staging of cT2aN0M0 (stage IB), we decided to surgically resect the lung cancer. Two months after the nodule was detected, we performed a repeat CT scan (Synapse Vincent; Fujifilm Medical, Tokyo, Japan) to prepare a preoperative three-dimensional imaging of the pulmonary vessels and bronchi. 2017; 28: 502-4 Pancreatic metastasis from non-small-cell lung cancer diagnosed using endoscopic ultrasound-guided fine needle aspiration biopsy: A case report 502 ABSTRACT A 56-year-old man presented with a chest computed tomography (CT) finding of a right upper lobe nodule, which was diagnosed using brush cytology as adenocarcinoma stage IB (cT2aN0M0). Repeat CT scan for preoperative evaluation revealed a small, slightly hypodense spot in the pancreatic body, which was diagnosed as pancreatic metastasis from lung cancer using endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB). Because of the presence of distant metastasis, surgical resection was deferred and chemotherapy was chosen instead. Pancreatic metastasis from non-small-cell lung cancer (NSCLC) is rare and might present with few symptoms when the tumor is small. EUS-FNAB is a useful modality for detecting and providing accurate histological diagnosis of pancreatic tumors. Although pancreatic metastasis...

A Rare Case of Non–Small Cell Lung Metastases Mimicking Primary Pancreatic Adenocarcinoma

“…A case similar to ours was published in 2017; however, a preoperative diagnosis of metastatic NSCLC was confirmed by EUS fine-needle aspiration biopsy 5 . The patient underwent weekly carboplatin and clitaxel but died 3 months after detection 5 .…”

A rare case of pancreatic metastasis of lung adenocarcinoma

“…There is not enough data on this issue. These pancreatic metastases of lung cancers would represent <5% in patients living with a pancreatic tumor [ 3 ]. According to Adsay et al.…”

“…Its prognosis remains guarded given the often advanced stage of the pathology. Several methods of treatment as surgery management, chemotherapy and/or preoperative radiotherapy were proposed [ 3 ].…”

“…These metastases may raise a diagnosis issue between a primary pancreatic or secondary lung cancer localization. In most cases, this diagnosis is made at a stage of multiple metastases in patients known to have primary lung cancer [ 3 ]. In the literature, most of the data have been provided by post-mortem examination of patients with primary lung cancer.…”

Distant organ metastasis patterns in lung cancer patients with pancreatic metastasis – a cluster analysis

“…18F-fluorodeoxyglucose uptake in pancreatic lesions was confirmed in patients who could perform FDG-PET. Then, based on images of pathologically-confirmed pancreatic metastasis from lung cancer [16][17][18][19][20][21][22][23][24][25][26], a diagnosis was made in the following conditions:…”