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

Abstract

Pancreatic metastasis from colorectal cancer is rare, and there have been only a few reports of its preoperative diagnosis by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with immunohistochemical staining. We herein describe the case of a 77-year-old woman in whom a solitary mass in the pancreatic tail was detected 11 years after rectal cancer resection. The patient also had a history of pulmonary tumor resection. We performed EUS-FNA and a histopathological examination showed adenocarcinoma with CD20+, CD7-, and CDX2+ (similar to her rectal cancer). EUS-FNA enabled a histopathological examination, including immunohistochemical staining, which helped to confirm the diagnosis of pancreatic and pulmonary metastasis from rectal cancer.

Metachronous Pancreatic Metastasis from Rectal Cancer that Masqueraded as a Primary Pancreatic Cancer: A Rare and Difficult-to-Diagnose Metastatic Tumor in the Pancreas

“…The median interval between resection of the primary cancer and development of pancreatic metastases is relatively longer, being reportedly 32.5–157 months [5,7–9,20]. Pancreatic metastases appearing long after the initial surgery (>5 years) have been documented [4]. However, T1 colorectal cancers according to TNM classification [19] (i.e., oncological depth within submucosal layer) rarely cause pancreatic metastases [9].…”

“…Accurate preoperative diagnosis of pancreatic metastasis rather than a primary pancreatic cancer is difficult [7–10,12]. Cytological examination of a fine needle aspirate or pathological examination of a biopsy specimen obtained under endoscopic ultrasonography guidance is useful for preoperative diagnosis [4,8,9,20,21]. In our case, although pathological assessment of a biopsy specimen suggested moderately-differentiated tubular adenocarcinoma, it was not possible to make a definite preoperative diagnosis of pancreatic metastasis originating from rectal cancer, which was regrettable given the impact the diagnosis made on subsequent management.…”

“…The usefulness of immunohistological staining for cytokeratin 7, cytokeratin 20, and caudal type homeobox transcription factor 2 is well-documented [4,7,9,14]. Negativity for cytokeratin 7 and positivity for cytokeratin 20 favor colorectal cancer over primary pancreatic cancer [7,9]; however, immunohistological assessment is not practicable as an intraoperative diagnostic tool.…”

A pancreatic metastasis from a colon carcinoma mimicking a primary tumor diagnosed by EUS-guided fine-needle biopsy

“…[ 2 ] As documented, they can appear long after the initial surgery and primary cancer most frequently associated is renal cell carcinoma. [ 3 ‑ 6 ] A histopathologycal preoperative diagnosis is very challenging.…”

Pancreatic Metastasis of a Colic Carcinoma

“…In operated patients, examination is performed on the specimen when pancreatic excision has been performed, or on biopsy specimens. In nonoperated patients, the alternative is to perform a fine needle biopsy guided by echoendoscopy [5].…”