Division of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Cancer Control. 2020 Jan-Dec;27(1):1073274820904042. doi: 10.1177/1073274820904042.
Pancreatic ductal adenocarcinoma behaves aggressively, with surgically resectable disease having the best chance of long-term survival. Recurrence after surgery and adjuvant therapy is commonly due to distant metastatic disease and is typically managed with systemic therapies, not surgery. We present a rare case of an isolated gastric metastasis due to endoscopic ultrasound-guided with fine-needle aspiration (EUS-FNA) needle tract seeding that was managed surgically. Treatment was informed by input from a mutlidisciplinary team of medical, surgical, and radiation oncologists, radiologists, and pathologists. Rising carbohydrate antigen (CA)19-9 levels suggested disease recurrence, but the tumor's unusual location and slow growth made diagnosing the cause difficult, resulting in the late identification of the tumor. Palliative resection was performed, rending the patient with no evidence of disease followed by normalized CA19-9 levels. This case highlights the importance of multidisciplinary decision-making in detecting and treating the uncommon but significant tumor seeding with EUS-FNA biopsies in pancreatic ductal adenocarcinoma.
胰腺导管腺癌具有侵袭性，手术可切除的肿瘤具有长期生存的最佳机会。手术后和辅助治疗后的复发通常是由于远处转移疾病引起的，通常采用系统治疗而不是手术治疗。我们报告了一例罕见的因内镜超声引导下细针抽吸（EUS-FNA）针道种植导致的孤立性胃转移病例，该病例通过手术进行了治疗。治疗方案由医学、外科和放射肿瘤学家、放射科医生和病理学家组成的多学科团队提供意见。碳水化合物抗原（CA）19-9 水平升高提示疾病复发，但肿瘤的位置不常见且生长缓慢，导致难以诊断病因，从而导致肿瘤的晚期发现。进行姑息性切除，使患者无疾病证据，随后 CA19-9 水平正常化。该病例强调了在胰腺导管腺癌中，通过 EUS-FNA 活检检测和治疗罕见但重要的肿瘤种植时，多学科决策的重要性。
