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KMID : 1143920220260010091
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Annals of Hepato-Biliary-Pancreatic Surgery
2022 Volume.26 No. 1 p.91 ~ p.97
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Metastatic tumors to the pancreas: Balancing clinical impression with cytology findings
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Abdallah Mohamed A.
Bohy Kimberlee
Singal Ashwani
Xie Chencheng
Patel Bhaveshkumar
Nelson Morgan E.
Bleeker Jonathan
Askeland Ryan
Abdullah Ammar
Aloreidi Khalil
Atiq Muslim
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Abstract
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Backgrounds/Aims: Metastatic lesions of the pancreas (PMET) account for 1%?5% of all malignant solid pancreatic lesions (SPL). In this study we evaluated the utility of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) in diagnosing PMET.
Methods: Patients who underwent EUS-FNA at a community referral center between 2011?2017 for SPL were identified. Clinical, radiologic, and EUS-FNA features of those with PMET were compared to those with primary solid tumors of the pancreas: pancreatic adenocarcinoma (PDAC) and neuroendocrine tumors (PNET).
Results: A total of 191 patients were diagnosed with solid pancreatic malignancy using EUS-FNA: 156 PDAC, 27 PNET, and eight (4.2%) had PMET. Patients with PMET were less likely to have abdominal pain (25.0% vs. 76.3% vs. 48.2%; p < 0.01) or obstructive jaundice (37.5% vs. 58.3% vs. 0%; p < 0.01) compared to PDAC and PNET. Those with PMET were more likely to have mass lesions with/without biliary or pancreatic ductal dilatations (100% vs. 86.5% vs. 85.2%; p < 0.01) and lower CA19-9 (82.5 ± 43.21 U/mL vs. 4,639.30 ± 11,489.68 U/mL vs. 10.50 ± 10.89 U/mL; p < 0.01) compared to PDAC and PNET. Endosonographic features were similar among all groups. Seven (87.5%) patients with PMET had a personal history of malignancy prior to PMET diagnosis. The primary malignancy was renal cell carcinoma in five PMET.
Conclusions: PMET are exceedingly rare, comprising less than 5% of SLP. Patients with PMET are less likely to present with symptoms and mostly identified by surveillance imaging for the primary malignancy.
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KEYWORD
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Endosonography, Biopsy, fine-needle, Neoplasm metastasis, Neuroendocrine tumors, Pancreatic neoplasms
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