Gastric metastasis from needle tract seeding after endoscopic ultrasound-guided fine needle aspiration of a cancer of the pancreatic body and tail

Abstract

A 78-year-old female underwent distal pancreatectomy for cancer of the pancreatic body and tail diagnosed by trans-gastric endoscopic-guided fine needle aspiration (EUS-FNA). Pathological findings showed invasive ductal carcinoma T2N0M0 (JPS7^th). The patient received S-1 therapy as postoperative chemotherapy for 6 months. Four and a half years after resection, a positron emission tomography computed tomography scan showed strong uptake in the proximal posterior gastric body wall (SUV max=6.9), and esophagogastroduodenoscopy (EGD) revealed a submucosal tumor (SMT) near the puncture site from the previous EUS-FNA. Biopsy of of the SMT showed tubular adenocarcinoma resembling the resected pancreatic cancer. A partial gastrectomy was performed for suspected needle tract seeing in the gastric wall. Comparing immunostaining of the primary pancreatic cancer and the gastric wall SMT, we diagnosed needle tract seeding caused by EUS-FNA. Needle tract seeding caused by EUS-FNA must be considered, and we suggest EGD as regular follow-up for the early diagnosis of needle tract seeding.