Pancreatic metastasis from osteosarcoma and Ewing sarcoma: literature review

Abstract

Objectives: Pancreatic metastasis from osteosarcoma and Ewing sarcoma is extremely rare. Differential diagnosis with primary pancreatic carcinoma is crucial before any treatment, but may be very difficult.

Material and methods: We searched for and reviewed the cases reported in the English literature.

Results: Twelve cases were identified, including nine osteosarcoma patients and three Ewing sarcoma cases. The median time between the sarcoma diagnosis and that of pancreatic metastasis was 3 years. In most of the cases, the pancreatic relapse followed or was associated with relapse(s) in one or more sites. Two out of eight patients with available follow-up were alive without disease 6+ and 11+ months after complete surgical removal, whereas five patients died from disease. Histological diagnosis was obtained before surgery in only five cases using percutaneous Tru-Cut biopsy in three cases and endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) in the two most recent ones.

Conclusions: Osteosarcoma or Ewing sarcoma metastasis should be included in the differential diagnosis of pancreatic solid lesion, particularly in patients with a primary tumor. In this context, EUS and EUS-FNAB are reliable methods for the pre-operative diagnosis and should thus be discussed before any therapeutic decision.