An unusual lesion of the pancreas

Phyllode breast tumors are rare fibroepithelial entities that may become malignant. They represent less than 1 % of all primary breast tumors [1]. Management is essentially surgical. The risk of local or metastatic recurrence varies by histological type, but most cases exhibit benign local evolution. The most common metastatic sites are the lungs and bones. No adjuvant treatment (radiotherapy or chemotherapy) is effective. Only five pancreatic metastases have been recorded in the literature, of which only one was diagnosed via endoscopy ultrasound [2] [3] [4]. We present the first video recording of endoscopic ultrasound used to diagnose a pancreatic metastasis of a phyllode tumor ([Video 1]); the diagnosis was histologically confirmed.

Video 1 Endoscopic ultrasound with fine-needle aspiration was used to diagnose a pancreatic metastasis of a phyllode tumor.

We excised a phyllode breast tumor, 30 cm in diameter, from a 47-year-old woman. The tumor was considered benign; we did not schedule any additional treatment or surveillance. Computed tomography was performed 5 years later to explore asthenia and weight loss associated with abdominal pain. We found a large (9 cm diameter) mass in the body of the pancreas ([Fig. 1]), associated with secondary pulmonary masses, suggestive of a primitive pancreatic origin. Endoscopic ultrasonography revealed a large lesion in the body of the pancreas. The tumor was hypoechogenic and heterogeneous in appearance, and featured diffuse millimeter-scale cysts. Many hypoechogenic lesions were also evident in the head of the pancreas.

Fig. 1 Computed tomography scan showed a mass in the body of the pancreas, which was associated with secondary pulmonary masses, suggestive of a primitive pancreatic origin.

We performed endoscopic ultrasound-guided fine-needle aspiration (FNA) using a 19-G needle ([Fig. 2]). Histology revealed proliferation of densely cellular fusiform cells, the immunohistochemical appearance of which was compatible with a secondary phyllode tumor derived from the tumor removed 5 years earlier ([Fig. 3]). We scheduled palliative chemotherapy; the patient died a few months later.

Fig. 2 Endoscopic ultrasound-guided fine-needle aspiration of a large lesion with diffuse millimeter-scale cysts in the body of the pancreas.

Fig. 3 Histopathological examination of the pancreatic material. High-power magnification (× 20) showed hypercellular spindle cell proliferation in keeping with the stromal component of phyllode tumors.

Pancreatic metastases of phyllode tumors are very rare, but should be considered in those with a history of such breast tumors. A biopsy with a 19-G FNA needle or a new fine-needle biopsy needle, followed by immunohistochemical analysis, is necessary to confirm a diagnosis.

Endoscopy_UCTN_Code_CCL_1AF_2AF_3AC

Competing interests

None

• References

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• 2 Serikawa M, Sasaki T, Kobayashi K. et al. Malignant phyllodes tumor metastatic to the pancreas: a case report. article in Japanese Nihon Shokakibyo Gakkai Zasshi 2012; 109: 795-803
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