Ann Hepatobiliary Pancreat Surg.  2022 Feb;26(1):91-97. 10.14701/ahbps.21-111.

Metastatic tumors to the pancreas: Balancing clinical impression with cytology findings

• Abdallah MA
• Bohy K
• Singal A
• Xie C
• Patel B
• Nelson ME
• Bleeker J
• Askeland R
• Abdullah A
• Aloreidi K
• Atiq M

• KMID: 2526837
• DOI: http://doi.org/10.14701/ahbps.21-111

Abstract

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.

Keyword

Endosonography; Biopsy; fine-needle; Neoplasm metastasis; Neuroendocrine tumors; Pancreatic neoplasms

Figure

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  Fig. 1 (A) Pancreatic ductal adenocarcinoma cellular specimen composed of groups of disordered ductal cells having nuclear enlargement, size variation, and hyperchromatic nuclei with prominent nucleoli. (B) Pancreatic neuroendocrine tumor cellular specimen showing loosely cohesive and plasmacytoid cells with finely stippled chromatin and moderate amounts of finely granular cytoplasm. (C) Renal cell carcinoma cellular specimen composed of groups of enlarged nuclei with vacuolated cytoplasm and prominent nucleoli. (D) Small cell lung carcinoma cellular specimen composed of sheets of cells with salt and pepper chromatin, scant cytoplasm, and molding.

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