Synchronous Pancreatic Ductal Adenocarcinomas Diagnosed by Endoscopic Ultrasound-Guided Fine Needle Biopsy

• Published in: Gut and liver Vol. 9; no. 5; pp. 685 - 688
• Main Authors: Goong, Hyeon Jeong, Moon, Jong Ho, Choi, Hyun Jong, Lee, Yun Nah, Choi, Moon Han, Kim, Hee Kyung, Lee, Tae Hoon, Cha, Sang-Woo
• Format: Journal Article
• Language: English
• Published: Korea (South) Gut and Liver 01.09.2015; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Adenocarcinoma, Mucinous - diagnostic imaging; Adenocarcinoma, Mucinous - pathology; biopsy; carcinoma; Carcinoma, Pancreatic Ductal - diagnostic imaging; Carcinoma, Pancreatic Ductal - pathology; Case Report; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; large-core needle; Middle Aged; multiple primary; neoplasms; Neoplasms, Multiple Primary - diagnostic imaging; Neoplasms, Multiple Primary - pathology; Pancreas - pathology; pancreatic ductal; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; 내과학; Biopsy, large-core needle; Endoscopic ultrasound-guided fine needle aspiration; Carcinoma, pancreatic ductal; Neoplasms, multiple primary
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl14215

Cases of pancreatic ductal adenocarcinoma with multiple masses accompanying underlying pancreatic diseases, such as intraductal papillary mucinous neoplasm, have been reported. However, synchronous invasion without underlying pancreatic disease is very rare. A 61-year-old female with abdominal discomfort and jaundice was admitted to our hospital. Abdominal computed tomography (CT) revealed cancer of the pancreatic head with direct invasion of the duodenal loop and common bile duct. However, positron emission tomography-CT showed an increased standardized uptake value (SUV) in the pancreatic head and tail. We performed endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for the histopathologic diagnosis of the pancreatic head and the evaluation of the increased SUV in the tail portion of the pancreas, as the characteristics of these lesions could affect the extent of surgery. As a result, pancreatic ductal adenocarcinomas were confirmed by both cytologic and histologic analyses. In addition, immunohistochemical analysis of the biopsy specimens was positive for carcinoembryonic antigen and p53 in both masses. The two masses were ultimately diagnosed as pancreatic ductal adenocarcinoma, stage IIB, based on EUS-FNB and imaging studies. In conclusion, the entire pancreas must be evaluated in a patient with a pancreatic mass to detect the rare but possible presence of synchronous pancreatic ductal adenocarcinoma. Additionally, EUS-FNB can provide pathologic confirmation in a single procedure.