Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration: A case report and literature review

Kojima, Hideaki; Kitago, Minoru; Iwasaki, Eisuke; Masugi, Yohei; Matsusaka, Yasuhiro; Yagi, Hiroshi; Abe, Yuta; Hasegawa, Yasushi; Hori, Shutaro; Tanaka, Masayuki; Nakano, Yuichi; Takemura, Yusuke; Fukuhara, Seiichiro; Ohara, Yasuhiro; Sakamoto, Michiie; Okuda, S.; Kitagawa, Yuko

doi:10.3748/wjg.v27.i3.294

Cited by 22 publications

(34 citation statements)

References 37 publications

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“…However, in some cases, previously performed abdominal surgery with gastrointestinal reconstruction may not allow for the examination procedure, such as in the present case. Furthermore, the indication of biopsy for potential malignant tumors remains controversial because of the risk of tumor dissemination [3].…”

Section: Discussionmentioning

confidence: 99%

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Lymphoepithelial cyst mimicking pancreatic cancer: a case report and literature review

et al. 2021

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Background Pancreatic lymphoepithelial cyst (LEC) is a rare nonmalignant cyst consisting of a benign collection of keratinizing squamous epithelial cells with lymphoid tissue. Diagnosing LEC preoperatively is considered difficult because of its non-specific clinical features; therefore, LEC is generally treated the same as a malignant tumor. Case presentation Our case was a 65-year-old man who underwent pancreatoduodenectomy 3 years previously for carcinoma arising from the ampulla of Vater. A pancreatic mass in the remnant pancreatic tail was detected through follow-up abdominal contrast-enhanced computed tomography (CT). This revealed two adjacent ring-enhanced masses that had been in tight contact with the left diaphragm and were enlarged. The tumors had high signal intensity in diffusion-weighted images of magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography (FDG-PET) showed abnormal uptake (standardized uptake value maximum: 17.4). Therefore, we conducted a partial resection of the remnant pancreas with concomitant resection of the left diaphragm. Microscopically, one of the tumors revealed rare fragments of apparently benign squamous epithelium on a background of keratinous debris, cyst contents, and scattered lymphocytes, and the adjacent mass revealed infiltrated neutrophils. The histopathological diagnosis was an LEC with chronic abscess. The patient recovered uneventfully and was discharged on postoperative day 10. Conclusions We reported a rare case of LEC with chronic abscess that was positively visualized on FDG-PET. When a pancreatic malignancy cannot be excluded, surgical resection is considered inevitable.

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Section: Discussionmentioning

confidence: 99%

“…Endoscopic ultrasound guided fine-needle biopsy (EUS-FNA) is reported to be a useful modality for detecting the pathological features of LEC [2]. However, biopsy for a potential malignant tumor cannot be easily applied from the perspective of dissemination [3]. Therefore, it is important to make the diagnosis non-invasively if possible.…”

Section: Introductionmentioning

confidence: 99%

Lymphoepithelial cyst mimicking pancreatic cancer: a case report and literature review

et al. 2021

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“…Bile leakage may not only cause peritonitis but also peritoneal dissemination in cases of malignancy. Recently, cases of dissemination needle-tract seeding caused by EUS-FNA have been reported, most of which are needle-tract seeding being intragastric wall metastases, and peritoneal dissemination is rare [ 35 , 36 , 37 ]. Though the frequency of dissemination is extremely low, peritoneal dissemination via EUS-FNA is an issue because it impairs patient survival [ 37 ].…”

Section: Eus-fna Of the Gallbladdermentioning

confidence: 99%

“…Recently, cases of dissemination needle-tract seeding caused by EUS-FNA have been reported, most of which are needle-tract seeding being intragastric wall metastases, and peritoneal dissemination is rare [ 35 , 36 , 37 ]. Though the frequency of dissemination is extremely low, peritoneal dissemination via EUS-FNA is an issue because it impairs patient survival [ 37 ]. Thus, EUS-FNA is only indicated for gallbladder lesions when the lesion can be aspirated without passing the needle through the gallbladder lumen or lesions with wall thickening.…”

Section: Eus-fna Of the Gallbladdermentioning

confidence: 99%

The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions

Hijioka¹,

Nagashio²,

Ohba³

et al. 2021

Diagnostics

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Endoscopic ultrasonography (EUS) has greater spatial resolution than other diagnostic imaging modalities. In addition, if gallbladder lesions are found and gallbladder cancer is suspected, EUS is an indispensable modality, enabling detailed tests for invasion depth evaluation using the Doppler mode and ultrasound agents. Furthermore, for gallbladder lesions, EUS fine-needle aspiration (EUS-FNA) can be used to differentiate benign and malignant forms of conditions, such as xanthogranulomatous cholecystitis, and collect evidence before chemotherapy. EUS-FNA is also useful for highly precise and specific diagnoses. However, the prevention of bile leakage, an accidental symptom, is highly important. Advancements in next-generation sequencing (NGS) technologies facilitate the application of multiple parallel sequencing to EUS-FNA samples. Several biomarkers are expected to stratify treatment for gallbladder cancer; however, NGS can unveil potential predictive genomic biomarkers for the treatment response. It is believed that NGS may be feasible with samples obtained using EUS-FNA, further increasing the demand for EUS-FNA.

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“…What is more, numerous case reports of malignant seeding resulting from needle biopsies have been reported for different tumors and increasing caution is being observed in highly aggressive malignancies (8)(9)(10)(11)(12). There is a growing consensus that the true incidence of tumor seeding along the needle may be underestimated as not all cases can be diagnosed, and many patients die before these metastases become clinically apparent (13).…”

Section: Introductionmentioning

confidence: 99%

A Novel Biopsy Method Based on Bipolar Radiofrequency Biopsy Needles

2022

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Modern oncology increasingly relies on pathological, molecular, and genomic assessments of biopsied tumor tissue. However, the concern for bleeding complication and malignant seeding severely hinders the application of the biopsy tumor. Here, we developed a 16 G biopsy needle to contain two electrodes insulated from each other and connect to an radiofrequency generator. For evaluating hemostatic efficacy, 50 rabbits were randomly divided into two groups: warfarinization and non-warfarinization group. Two liver biopsies and two splenic biopsies per animal were performed using a 16 G biopsy needle. Each group was further equally divided into five groups according to different hemostatic measures, including non-intervention, embolization using an absorbable gelatin sponge, and ablation by RF with three different needle temperatures (50°C, 70°C, and 90°C). Than, we used VX2 rabbit models (n = 25) and applied the five analogous biopsies to the tumor. The flush fluid from the biopsy needle underwent cytomorphological analysis. Our results that the groups using ablation by RF showed significantly less blood loss than the control group for liver and spleen in both groups (P < 0.001). After RF ablation, thermal coagulation of the tissue surrounding the needle tract was observed on both the macroscopic and histological level. Cytological smears showed that tumor cells were degenerated after RF at 70°C and 90°C. Our findings showed that bipolar RF biopsy needle is a promising tool for reducing hemorrhage after biopsy and avoiding implanting tumor cells in the tract.

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Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration: A case report and literature review

Cited by 22 publications

References 37 publications

Lymphoepithelial cyst mimicking pancreatic cancer: a case report and literature review

Lymphoepithelial cyst mimicking pancreatic cancer: a case report and literature review

The Role of EUS and EUS-FNA in Differentiating Benign and Malignant Gallbladder Lesions

A Novel Biopsy Method Based on Bipolar Radiofrequency Biopsy Needles

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