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. 2017 Dec;3(1):39.
doi: 10.1186/s40792-017-0314-2. Epub 2017 Feb 25.

Two cases of resectable pancreatic cancer diagnosed by open surgical biopsy after endoscopic ultrasound fine-needle aspiration failed to yield diagnosis: case reports

Reishi Toshiyama  1 , Takehiro Noda  1 , Hidetoshi Eguchi  2 , Yoshifumi Iwagami  1 , Daisaku Yamada  1 , Tadafumi Asaoka  1 , Hiroshi Wada  1 , Koichi Kawamoto  1 , Kunihito Gotoh  1 , Yutaka Takeda  1   3 , Masahiro Tanemura  1   4 , Eiichi Morii  5 , Koji Umeshita  6 , Masaki Mori  1 , Yuichiro Doki  1
Affiliations

Two cases of resectable pancreatic cancer diagnosed by open surgical biopsy after endoscopic ultrasound fine-needle aspiration failed to yield diagnosis: case reports

Reishi Toshiyama et al. Surg Case Rep. 2017 Dec.

Abstract

Background: Tumor biopsy for histological diagnosis is required preoperatively and before initiating chemotherapy or radiation therapy for patients with pancreatic cancer (Cancer of the Pancreas: Clinical Practice Guidelines, European Society for Medical Oncology). Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is widely applied to obtain tissue samples for histological examination. However, in some cases, EUS-FNA cannot be performed safely or tissue samples are insufficient to establish a definitive diagnosis. We present two cases of pancreatic cancer diagnosed by open surgical biopsy after EUS-FNA failed to yield a diagnosis.

Case presentation: Case 1 was a 50-year-old man. Computed tomography showed a hypovascular lesion in the uncus of the pancreas. Although EUS-FNA was conducted twice, we could not collect enough quantity of tissue samples to establish a definitive diagnosis. Open surgical biopsy revealed adenocarcinoma, and the patient underwent preoperative chemoradiation therapy followed by curative operation. Case 2 was a 68-year-old man. Computed tomography showed a hypovascular tumor in the uncus of the pancreas. EUS revealed a 14-mm hypoechoic lesion, but we could not perform EUS-FNA because the superior mesenteric vein was located in the puncture line. Open surgical biopsy revealed adenocarcinoma, and the patient underwent preoperative chemoradiation therapy followed by pancreaticoduodenectomy.

Conclusions: EUS-FNA is the first choice in the diagnostic modalities of pancreatic neoplasm, but open surgical biopsy is an effective diagnostic method if EUS-FNA is unsuccessful.

Keywords: Intraoperative pancreas biopsy; Open surgical biopsy; Pancreatic cancer.

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Figures

Fig. 1
Fig. 1
Radiological and endoscopic ultrasonographic findings for case 1. a CECT revealed a hypovascular tumor in the uncus of the pancreas (red circle). b PET-CT revealed that 18 F-FDG accumulation was within normal range. c EUS revealed a 22-mm hypoechoic lesion in the uncus of the pancreas (red arrows)
Fig. 2
Fig. 2
Pathological analysis by EUS-FNA compared to open surgical biopsy in case 1. a Macroscopic view of specimen obtained by EUS-FNA. The specimen contained large quantities of blood clots. b Microscopic view of specimen (×100 magnification) revealed enlarged nuclei and disordered ductal structures. c Specimen obtained by open surgical biopsy. Most of the specimen consisted of pancreatic parenchyma. d Microscopic view of specimen obtained by open surgical biopsy (×100 magnification) revealed abundant dyskaryotic cells with enlarged nuclei, disordered ductal structures
Fig. 3
Fig. 3
Radiological and endoscopic ultrasonographic findings in case 2. a CECT revealed an 8-mm hypovascular tumor in the uncus of the pancreas. b PET-CT showed FDG accumulation (SUVmax 5.6) corresponding with the pancreas tumor. c EUS detected a 14 × 12-mm hypoechoic lesion in the uncus, but we could not perform EUS-FNA because the superior mesenteric vein was located in the puncture line
Fig. 4
Fig. 4
Pathological analysis by open surgical biopsy in case 2. a The biopsy specimen had dyskaryotic cells with enlarged nuclei and atypical irregular ductal structures. b Microscopic view of specimen (×100 magnification)
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