Pancreatic metastasis from gastric carcinoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration.

Upper digestive endoscopy in a 36-yearold woman complaining of epigastric pain revealed an ulcerative lesion in the gastric body (●" Fig.1a). Endoscopic biopsies confirmed a gastric adenocarcinoma (●" Fig.1b,c). Endoscopic ultrasonography for cancer staging demonstrated a T2 gastric lesion, and a solid lesion measuring 10.2mm×9.6mm in the pancreatic body (●" Fig.2a). Histologic analysis of biopsy samples obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA; ●" Fig.2b) showed neoplastic cells with the same histologic findings as those from the primary gastric cancer (●" Fig.2c). Chest and abdominal computed tomography detected additional lung and liver metastases, but no pancreatic lesion was found. Palliative chemotherapy was planned for the patient. Secondary involvement of the pancreas by systemic malignancies has been reported for up to 3% of solid pancreatic lesions [1], although in autopsy studies rates vary between 3% and 12% [2]. Renal carcinoma is the most common cancer to cause pancreatic metastases, followed by colorectal, lung, and breast carcinoma, as well as melanoma [3,4]. Hematogenic Fig.1 a A 1.2×0.8cm sized, Borrmann type 2 lesion at the greater curvature of the gastric body. b Histomorphologic appearance of the transition between neoplasia and normal gastric mucosa, demonstrating a poorly differentiated adenocarcinoma composed mainly of marked pleomorphic cells with signet ring cells (hematoxylin and eosin; original magnification×200). c High magnification image of endoscopic biopsy specimen, demonstrating gastric carcinoma with discohesive epithelial pleomorphic cells with signet ring cells (hematoxylin and eosin). Fig.2 a Linear-array endosonography demonstrating a hypoechoic homogeneous lesion with well-defined borders in the pancreatic body measuring 10.2× 9.6mm. Note the normal caliber of the main pancreatic duct on the righthand side of the figure and the lack of continuity of the lesion and the gastric wall. b Endoscopic ultrasound-guided fine-needle aspiration of the pancreatic nodule with a 22-gauge needle. c Poorly differentiated adenocarcinoma composed of discohesive, pleomorphic small and medium-sized malignant cells with occasional signet ring cells (cell block; hematoxylin and eosin; original magnification×200). Cases and Techniques Library (CTL) E271