Pancreatic Metastasis from Rectal Cancer that was Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Aspiration (EUS-FNA)

Abstract

Pancreatic metastasis from colorectal cancer is rare, and there have been only a few reports of its preoperative diagnosis by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with immunohistochemical staining. We herein describe the case of a 77-year-old woman in whom a solitary mass in the pancreatic tail was detected 11 years after rectal cancer resection. The patient also had a history of pulmonary tumor resection. We performed EUS-FNA and a histopathological examination showed adenocarcinoma with CD20+, CD7-, and CDX2+ (similar to her rectal cancer). EUS-FNA enabled a histopathological examination, including immunohistochemical staining, which helped to confirm the diagnosis of pancreatic and pulmonary metastasis from rectal cancer.

Figure 1.

A CT image: A hypodense mass of 30 mm in diameter in the pancreatic tail in the arterial phase (arrows) (a), with increasing enhancement in the equilibrium phase (arrows) (b).

Figure 2.

An EUS image: A hypoechoic mass in the pancreatic tail with an irregular lesion border.

Figure 3.

Histopathological sections: In the EUS-FNA specimen, Hematoxylin and Eosin (H&E) staining showing adenocarcinoma with tall columnar epithelial cells, sparse nuclear stratification and necrosis (a), CK7- (b), CK20+(c), and CDX2+(d). These findings were similar to the H&E staining findings (e), CK7- (f), CK20+(g), and CDX2+(h) in the resected primary rectal cancer specimen.

Figure 4.

Histopathological sections from the metastatic pulmonary tumor: Hematoxylin and Eosin staining showing adenocarcinoma (a), CK7- (b), CK20+(c), and CDX2+(d). These findings were the same as those in the primary rectal cancer.