SOLITARY NEEDLE TRACT SEEDING METASTASES FOLLOWING PANCREATIC CANCER RESECTIONS WITH PREVIOUS EUS-FNA

Aims:

Pancreatic cancer (PDAC) seeding metastases following EUS-FNA is not frequent. However, the accurate frequency of this dissemination of PDAC is not known. A progression of the disease recurrence leading to death during the first two years following radical surgery is faster than the growth of seeding metastasis into its detectable size. In a case, that an isolated seeding metastasis develops, it becomes a serious complication involving patient's prognosis. Reports regarding this kind of dissemination have been increasing during last few years. We present two cases of seeding metastases. One has been following left pancreatectomy. Second is an unique case of metastasis following pylorus preserving hemipancreatoduodenectomy, as there is not previously published such a case.

Methods:

Retrospective analysis of PDAC patients operated on with curative intent between 2010 – 2015 revealed two patients with previous EUS-FNA and subsequent recurrence in the stomach. Detailed histopathological analysis and comparison of primarily resected tumors and secondary resected metastases were performed.

Results:

Case 1. 75-yrs woman, PDAC located in head of the pancreas. CT, EUS-FNA, radical surgery were performed. Solitary lesion in pylorus of 20 mm was diagnosed by PET/CT scan15 months following radical surgery. Pyloric resection and histopathological analysis proved identical tumor. Overall survival was 29 months.

Case 2. 71-yrs woman, PDAC located in tail of the pancreas. CT, EUS-FNA, radical surgery were performed. Solitary lesion in gastric posterior wall of 18 mm was diagnosed by PET/CT scan 23 months following radical surgery. Gastrectomy and histopathological analysis proved histologically identical tumor. Actual survival is 53 months without recurrence.

Conclusions:

The indication of EUS-FNA should be prudent. If pre-operatively is required, the puncture channel should be removed during surgery. When tumor is located in the body or tail of pancreas, channel should be marked. If it is not possible, than should be carefully followed up its location and resected, when recurrence/seeding occurs.