Anaplastic carcinoma of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration: a case report and review of the literature

Abstract

Background: Anaplastic carcinoma of the pancreas is a rare pancreatic neoplasm with a poor prognosis. It is classified as a variant of ductal adenocarcinoma, but the clinical features and treatment of it remain unknown because of its rarity and aggressiveness. Endoscopic ultrasonography and endoscopic ultrasound-guided fine-needle aspiration are useful techniques for the diagnosis of pancreatic tumors with high sensitivity and specificity.

Case presentation: A 72-year-old Japanese woman presented with a diagnosis of acute pancreatitis, and a cystic lesion with slightly high density area was observed by computed tomography in her pancreatic head. In addition, endoscopic ultrasound revealed a heterogeneous lesion. Endoscopic ultrasound-guided fine-needle aspiration showed pleomorphic atypical cells. We diagnosed anaplastic carcinoma of the pancreas. We resected the lesion, and she has shown no sign of recurrence for > 6 months. There are few reports of anaplastic carcinoma of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration and treated by surgery. Our analysis indicates that anaplastic carcinoma of the pancreas is more likely than typical ductal carcinomas to have cystic lesions with the tumor.

Conclusions: We report a case of anaplastic carcinoma of the pancreas diagnosed by endoscopic ultrasound-guided fine-needle aspiration and subsequently resected with a clear margin. We speculate that anaplastic carcinoma of the pancreas is more likely to have cystic changes than pancreatic ductal adenocarcinoma. When we diagnose pancreas tumor as having cystic changes, anaplastic carcinoma of the pancreas should be considered one of the differential diagnoses.

Keywords: Anaplastic carcinoma of the pancreas; Cystic change; EUS-FNA.

Fig. 1

a, b CT showed a cystic mass in the pancreatic head (arrow). Slight fat stranding suggested that inflammation was localized to the pancreatic head. The MPD was dilated from the body to the tail (arrow). c The cystic mass was demonstrated as a hypo-echoic area under US (arrow). d MRCP showed that the MPD was obstructed by the cystic mass (arrow). e EUS revealed that the masswas 15 mm and comprise of both solid and cystic components (arrow). f ERP showed the MPD was obstructed for a 12-mm length (arrow). There was no obvious communication between the cystic mass and the MPD

Fig. 2

Findings obtained by endoscopic ultrasound-guided fine-needle aspiration. a Endoscopic ultrasound-guided fine-needle aspiration was performed to obtain cytology for the solid mass in the pancreatic head. b Histology showed pleomorphic large atypical cells (hematoxylin-eosin, magnitude × 400). c Cytokeratin AE1/AE3 stain was positive, and thus these cells were epithelial cells (cytokeratin AE1/AE3, magnitude × 400)

Fig. 3

The patient’s clinical course. This graph shows serum level of amylase and 10-point numerical rating scale on abdominal pain. Both of them improved immediately, except for temporary elevation of serum level of amylase after the endoscopic retrograde cholangiopancreatography procedure. AMY serum amylase, ERCP endoscopic retrograde cholangiopancreatography, EUS-FNA endoscopic ultrasound-guided fine-needle aspiration, NRS numerical rating scale

Fig. 4

Resected specimen findings. a The tumor was not clearly exposed to the surface of the pancreas. b The tumor consisted of a yellow nodular mass with the cystic lesion in the center of the mass. The cystic lesion was pathologically a pancreatic duct. A pancreatic calculus was found in this specimen. c, d Hematoxylin-eosin staining showed spindle cells and multinuclear giant cells, which are characteristic of anaplastic carcinoma of the pancreas. e, f These cells exhibited immunoreactivity for cytokeratin AE1/AE3. The tumor invaded pancreatic anterior fat tissue