Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • Mohamed A. Abdallah (Department of Internal Medicine, University of South Dakota Sanford School of Medicine) ;
  • Kimberlee Bohy (Department of Pathology, University of South Dakota Sanford School of Medicine) ;
  • Ashwani Singal (Department of Internal Medicine, University of South Dakota Sanford School of Medicine) ;
  • Chencheng Xie (Department of Internal Medicine, University of South Dakota Sanford School of Medicine) ;
  • Bhaveshkumar Patel (Department of Internal Medicine, University of South Dakota Sanford School of Medicine) ;
  • Morgan E. Nelson (Department of Internal Medicine, University of South Dakota Sanford School of Medicine) ;
  • Jonathan Bleeker (Department of Internal Medicine, University of South Dakota Sanford School of Medicine) ;
  • Ryan Askeland (Department of Pathology, University of South Dakota Sanford School of Medicine) ;
  • Ammar Abdullah (Department of Internal Medicine, University of South Dakota Sanford School of Medicine) ;
  • Khalil Aloreidi (Department of Internal Medicine, University of South Dakota Sanford School of Medicine) ;
  • Muslim Atiq (Department of Internal Medicine, University of South Dakota Sanford School of Medicine)
  • Received : 2021.07.26
  • Accepted : 2021.10.19
  • Published : 2022.02.28
Download PDF
⟨ Previous Next ⟩

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.

Keywords

Acknowledgement

This manuscript was presented as an abstract at the American Journal of Gastroenterology meeting in San Antonio, Texas, USA in October 2019 (abstract number 2791, volume 114).

References

  1. Feldmann G, Beaty R, Hruban RH, Maitra A. Molecular genetics of pancreatic intraepithelial neoplasia. J Hepatobiliary Pancreat Surg 2007;14:224-232. https://doi.org/10.1007/s00534-006-1166-5
  2. Gagovic V, Spier BJ, DeLee RJ, Barancin C, Lindstrom M, Einstein M, et al. Endoscopic ultrasound fine-needle aspiration characteristics of primary adenocarcinoma versus other malignant neoplasms of the pancreas. Can J Gastroenterol 2012;26:691-696. https://doi.org/10.1155/2012/761721
  3. Alzahrani MA, Schmulewitz N, Grewal S, Lucas FV, Turner KO, McKenzie JT, et al. Metastases to the pancreas: the experience of a high volume center and a review of the literature. J Surg Oncol 2012;105:156-161. https://doi.org/10.1002/jso.22009
  4. Krishna SG, Bhattacharya A, Ross WA, Ladha H, Porter K, Bhutani MS, et al. Pretest prediction and diagnosis of metastatic lesions to the pancreas by endoscopic ultrasound-guided fine needle aspiration. J Gastroenterol Hepatol 2015;30:1552-1560. https://doi.org/10.1111/jgh.12973
  5. Sperti C, Pozza G, Brazzale AR, Buratin A, Moletta L, Beltrame V, et al. Metastatic tumors to the pancreas: a systematic review and meta-analysis. Minerva Chir 2016;71:337-344.
  6. Atiq M, Bhutani MS, Ross WA, Raju GS, Gong Y, Tamm EP, et al. Role of endoscopic ultrasonography in evaluation of metastatic lesions to the pancreas: a tertiary cancer center experience. Pancreas 2013;42:516-523. https://doi.org/10.1097/MPA.0b013e31826c276d
  7. Layfield LJ, Hirschowitz SL, Adler DG. Metastatic disease to the pancreas documented by endoscopic ultrasound guided fine-needle aspiration: a seven-year experience. Diagn Cytopathol 2012;40:228-233. https://doi.org/10.1002/dc.21564
  8. Adsay NV, Andea A, Basturk O, Kilinc N, Nassar H, Cheng JD. Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature. Virchows Arch 2004;444:527-535. https://doi.org/10.1007/s00428-004-0987-3
  9. Turner BG, Cizginer S, Agarwal D, Yang J, Pitman MB, Brugge WR. Diagnosis of pancreatic neoplasia with EUS and FNA: a report of accuracy. Gastrointest Endosc 2010;71:91-98. https://doi.org/10.1016/j.gie.2009.06.017
  10. Waters L, Si Q, Caraway N, Mody D, Staerkel G, Sneige N. Secondary tumors of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a 10-year experience. Diagn Cytopathol 2014;42:738-743. https://doi.org/10.1002/dc.23114
  11. Smith AL, Odronic SI, Springer BS, Reynolds JP. Solid tumor metastases to the pancreas diagnosed by FNA: a single-institution experience and review of the literature. Cancer Cytopathol 2015;123:347-355. https://doi.org/10.1002/cncy.21541
  12. Raymond SLT, Yugawa D, Chang KHF, Ena B, Tauchi-Nishi PS. Metastatic neoplasms to the pancreas diagnosed by fine-needle aspiration/biopsy cytology: a 15-year retrospective analysis. Diagn Cytopathol 2017;45:771-783. https://doi.org/10.1002/dc.23752
  13. Olson MT, Wakely PE Jr, Ali SZ. Metastases to the pancreas diagnosed by fine-needle aspiration. Acta Cytol 2013;57:473-480. https://doi.org/10.1159/000352006
  14. Sellner F, Tykalsky N, De Santis M, Pont J, Klimpfinger M. Solitary and multiple isolated metastases of clear cell renal carcinoma to the pancreas: an indication for pancreatic surgery. Ann Surg Oncol 2006;13:75-85. https://doi.org/10.1245/ASO.2006.03.064
  15. El Hajj II, LeBlanc JK, Sherman S, Al-Haddad MA, Cote GA, McHenry L, et al. Endoscopic ultrasound-guided biopsy of pancreatic metastases: a large single-center experience. Pancreas 2013;42:524-530. https://doi.org/10.1097/MPA.0b013e31826b3acf
  16. Hult M, Sandstrom H, Wittendorff HE. [Prostate cancer presenting with diffuse infiltration of metastases to the pancreas]. Ugeskr Laeger 2015;177:V09140491. Danish.
  17. O'Toole D, Palazzo L, Arotcarena R, Dancour A, Aubert A, Hammel P, et al. Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc 2001;53:470-474. https://doi.org/10.1067/mge.2001.112839