A Case of Pancreatic Cancer with Gastric Wall Metastasis Caused by Needle Tract Seeding after Endoscopic Ultrasound with Fine Needle Aspiration

Abstract

A 62-year-old man with a 5-cm mass in the pancreatic tail was diagnosed with pancreatic cancer by endoscopic ultrasound with fine needle aspiration (EUS-FNA), and he underwent pancreatic tail resection. The pathological diagnosis was moderately differentiated tubular adenocarcinoma (pT3 N1 M0 fStage IIB). The patient underwent postoperative adjuvant chemotherapy with S-1, but 13 months postoperatively, he presented with hematemesis. Upper gastrointestinal endoscopy showed an elevated lesion in the posterior wall of the upper gastric corpus, and histological testing of the biopsy tissue showed that it was tubular adenocarcinoma resembling the resected pancreatic cancer. Positron emission tomography (PET) showed abnormal accumulation in the posterior wall of the stomach, but there were no other signs of recurrence, and partial gastrectomy was performed. On histopathological examination, there was proliferation of tubular adenocarcinoma through all layers of the gastric wall. No gastric lesion had been evident prior to pancreatic cancer surgery, and taken in conjuction with the clinical course, gastric wall metastasis caused by needle tract seeding of the pancreatic cancer was diagnosed. When performing EUS-FNA of lesions in the pancreatic tail, because the puncture site is not within the resected area, great care is required to avoid causing postoperative gastric wall metastases.