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      EUS-FNA Diagnosis with Core Biopsy of Pancreatic Metastases from Primary Breast Cancer

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          Abstract

          Background

          The pancreas as a site of metastasis of other primary tumors is a rare event. Pancreatic metastases may occur years after the start of treatment of a neoplasm of another organ or may be the initial manifestation of an unidentified primary tumor. The most commonly reported primary sites for pancreatic metastases are the kidneys, lungs, breast, bowel, and skin (melanoma). Case Summary. The authors report a case of pancreatic metastasis derived from a primary breast cancer that underwent endoscopic ultrasound fine-needle aspiration (EUS-FNA) core biopsy to obtain tissue, which made it possible to perform an immunohistochemical study.

          Conclusion

          We emphasize the importance of outpatient follow-up after the treatment of a neoplasia and the completion of control exams. In addition, we should always be aware of the finding of a secondary lesion in patients who have already been diagnosed with cancer, even if it is located in unusual organs, as in this case, where two metastases of a breast carcinoma to the pancreas were detected.

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          Contrast harmonic endoscopic ultrasonography in the characterization of pancreatic metastases (with video).

          The differential diagnosis between primary pancreatic neoplasms versus pancreatic metastases (PM) is challenging. Endoscopic ultrasonography with fine-needle aspiration can be used to differentiate primary versus metastatic tumors although with a suboptimal accuracy. Recently, contrast harmonic EUS (CH-EUS) has been reported as an adjunct in the diagnosis of pancreatic neoplasms. We evaluated the potential role of CH-EUS in the differential diagnosis of PM.
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            Metastases to the Pancreas Encountered on Endoscopic Ultrasound-Guided, Fine-Needle Aspiration.

            Metastatic lesions in the pancreas are very uncommon and may be difficult to differentiate from the more commonly encountered primary neoplasms derived from the exocrine and endocrine pancreas because of the significant overlap in clinical presentation, imaging, and cytologic features. Metastasis to the pancreas may occur years after treatment of the primary neoplasm and is often not considered on initial evaluation because of the rarity of such events. The possibility of a metastasis to the pancreas should be entertained in patients with any prior history of malignancy because a proper diagnosis is essential in identifying surgical candidates, or avoiding potentially unnecessary surgery and facilitating triage to more appropriate nonoperative therapy. Herein, we describe intrapancreatic metastases secondary to renal cell carcinoma, melanoma, and lung carcinoma, as documented by cytologic examination of endoscopic ultrasound-guided fine-needle aspiration of the pancreatic masses.
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              Role of endoscopic ultrasonography in evaluation of metastatic lesions to the pancreas: a tertiary cancer center experience.

              Metastatic lesions to the pancreas pose diagnostic challenges with regards to their differentiation from primary pancreatic cancer. Data on the yield of endoscopic ultrasonography (EUS)-guided fine-needle aspiration in detection of these lesions are limited.
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                Author and article information

                Contributors
                Journal
                Case Rep Gastrointest Med
                Case Rep Gastrointest Med
                CRIGM
                Case Reports in Gastrointestinal Medicine
                Hindawi
                2090-6528
                2090-6536
                2020
                16 September 2020
                : 2020
                : 7136897
                Affiliations
                1Gastrointestinal Endoscopy, Department of Gastrointestinal Endoscopy, Hospital 9 de Julho, São Paulo, Brazil
                2Department of Radiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
                3Hospital do Servidor Público Municipal, São Paulo, Brazil
                4Gastrointestinal Endoscopy Service, Department of Gastrointestinal Endoscopy, Hospital das Clinicas, University of São Paulo Riberão Preto, São Paulo, Brazil
                Author notes

                Academic Editor: Yoshihiro Moriwaki

                Author information
                https://orcid.org/0000-0003-2301-5363
                https://orcid.org/0000-0002-5932-2499
                Article
                10.1155/2020/7136897
                7516693
                33014479
                a1c2dae6-82ef-4455-bdd6-d9fa5b7cbf25
                Copyright © 2020 Samuel Galante Romanini et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 March 2020
                : 30 July 2020
                : 6 September 2020
                Categories
                Case Report

                Gastroenterology & Hepatology
                Gastroenterology & Hepatology

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