Gut Liver.  2015 Sep;9(5):685-688. 10.5009/gnl14215.

Synchronous Pancreatic Ductal Adenocarcinomas Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Biopsy

• Goong HJ
• Moon JH
• Choi HJ
• Lee YN
• Choi MH
• Kim HK
• Lee TH
• Cha SW

• KMID: 2234077
• DOI: http://doi.org/10.5009/gnl14215

Abstract

Cases of pancreatic ductal adenocarcinoma with multiple masses accompanying underlying pancreatic diseases, such as intraductal papillary mucinous neoplasm, have been reported. However, synchronous invasion without underlying pancreatic disease is very rare. A 61-year-old female with abdominal discomfort and jaundice was admitted to our hospital. Abdominal computed tomography (CT) revealed cancer of the pancreatic head with direct invasion of the duodenal loop and common bile duct. However, positron emission tomography-CT showed an increased standardized uptake value (SUV) in the pancreatic head and tail. We performed endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for the histopathologic diagnosis of the pancreatic head and the evaluation of the increased SUV in the tail portion of the pancreas, as the characteristics of these lesions could affect the extent of surgery. As a result, pancreatic ductal adenocarcinomas were confirmed by both cytologic and histologic analyses. In addition, immunohistochemical analysis of the biopsy specimens was positive for carcinoembryonic antigen and p53 in both masses. The two masses were ultimately diagnosed as pancreatic ductal adenocarcinoma, stage IIB, based on EUS-FNB and imaging studies. In conclusion, the entire pancreas must be evaluated in a patient with a pancreatic mass to detect the rare but possible presence of synchronous pancreatic ductal adenocarcinoma. Additionally, EUS-FNB can provide pathologic confirmation in a single procedure.

Keyword

Carcinoma, pancreatic ductal; Neoplasms, multiple primary; Endoscopic ultrasound-guided fine needle aspiration; Biopsy, large-core needle

MeSH Terms

Adenocarcinoma, Mucinous/pathology/*ultrasonography
Carcinoma, Pancreatic Ductal/pathology/*ultrasonography
*Endoscopic Ultrasound-Guided Fine Needle Aspiration
Female
Humans
Middle Aged
Neoplasms, Multiple Primary/pathology/*ultrasonography
Pancreas/pathology
Pancreatic Neoplasms/pathology/*ultrasonography