Sawai Go, Dainaka Katsuyuki, Juichiro Yoshida, Inada Yutaka, Fukui Akifumi, Nishimura Takeshi, Fujii Hideki, Tomatsuri Naoya, Okuyama Yusuke, Sato Hideki
Department of Gastroenterology and Hepatology Japanese Red Cross Society Kyoto Daiichi Hospital Kyoto Japan.
DEN Open. 2024 Apr 21;4(1):e368. doi: 10.1002/deo2.368. eCollection 2024 Apr.
An 83-year-old male underwent three transgastric punctures with endoscopic ultrasound-guided fine-needle aspiration for the examination of a pancreatic body tumor. After a diagnosis of resectable pancreatic cancer and undergoing distal pancreatectomy, the patient was administered postoperative adjuvant chemotherapy with oral S-1 for 6 months, and carcinoembryonic antigen and carbohydrate antigen 19-9 levels were bimonthly evaluated. Carbohydrate antigen 19-9 levels continually increased to 4638.1 U/mL at 45 months post-fine-needle aspiration. Endoscopic ultrasound-guided showed a 25 mm low-echoic, irregularly shaped, and heterogeneous tumor with clear margins protruding from the mucosa outside the gastric wall, and biopsy confirmed adenocarcinoma. Since the immunostaining findings of the specimen matched those of the previously resected specimen, needle tract seeding (NTS) due to puncture of the pancreatic cancer was identified as the cause. After a pylorus-preserving gastrectomy at 46 months post-fine-needle aspiration, postoperative chemotherapy initiation, comprising gemcitabine and nab-paclitaxel, was initiated; however, the patient died despite these interventions as he developed multiple peritoneal dissemination. Although rare, the incidence of NTS will increase in the future owing to the expected extended survival in post-pancreatic cancer resection cases. We suggest regular upper gastrointestinal endoscopy and endoscopic ultrasound-guided evaluations for patients who are at risk for NTS can facilitate early detection. Furthermore, it is extremely relevant to share experiences of encountered NTS cases in practice and extend knowledge of its varying endoscopic appearances.
一名83岁男性接受了三次经胃穿刺内镜超声引导下细针穿刺活检，以检查胰体部肿瘤。在诊断为可切除胰腺癌并接受胰体尾切除术后，患者接受了为期6个月的口服S-1术后辅助化疗，并每两个月评估癌胚抗原和糖类抗原19-9水平。细针穿刺活检后45个月时，糖类抗原19-9水平持续升高至4638.1 U/mL。内镜超声引导显示一个25 mm的低回声、形状不规则且不均匀的肿瘤，边界清晰，从胃壁外的黏膜突出，活检确诊为腺癌。由于标本的免疫染色结果与先前切除标本的结果相符，因此确定胰腺癌穿刺导致的针道种植（NTS）为病因。细针穿刺活检后46个月进行了保留幽门的胃切除术后，开始了包括吉西他滨和纳米白蛋白结合型紫杉醇的术后化疗；然而，尽管采取了这些干预措施，患者仍因出现多处腹膜播散而死亡。尽管NTS罕见，但由于胰腺癌切除术后患者预期生存期延长，未来NTS的发生率将会增加。我们建议对有NTS风险的患者定期进行上消化道内镜检查和内镜超声引导评估，以促进早期发现。此外，在实践中分享遇到的NTS病例经验并扩展其不同内镜表现的知识非常重要。
