Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5764-5769
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5764
Simultaneous multiple primary malignancies diagnosed by endoscopic ultrasound-guided fine-needle aspiration: A case report
Jian Yang, Yan Zeng, Jun-Wen Zhang
Jian Yang, Jun-Wen Zhang, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Yan Zeng, Department of Psychology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Author contributions: Yang J, Zeng Y and Zhang JW designed and performed the research; Yang J and Zhang JW performed EUS-FNA; Yang J and Zeng Y analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: No conflict of interest exists in the submission of this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Wen Zhang, MD, Chief Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. 959308413@qq.com
Received: November 8, 2021
Peer-review started: November 8, 2021
First decision: January 11, 2022
Revised: January 13, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: June 16, 2022
Processing time: 213 Days and 5.2 Hours
Abstract
BACKGROUND

Multiple primary malignancies (MPMs) refer to more than one primary malignancy in the same or separate organs of the same patient, and MPMs are considered when different histological characteristics are detected in epidemiological studies. Herein, we report a case presumed to be primary pancreatic cancer with multiple liver metastases by positron-emission tomography/computed tomography (PET/CT) and confirmed to be synchronous liver and pancreatic MPMs by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).

CASE SUMMARY

A 50-year-old man was referred to our hospital due to abdominal discomfort for 2 mo. Abdominal CT at a local hospital revealed a pancreatic mass with multiple liver nodules. After being transferred to our hospital, PET/CT confirmed all these lesions to have elevated metabolic activity, and therefore primary pancreatic cancer with multiple liver metastases was considered. EUS-guided liver aspiration unexpectedly found signet-ring cells with a high Ki-67 positive rate (20%), while EUS-guided pancreatic aspiration detected pancreatic neuroendocrine cells with a relatively low Ki-67 positive rate (1%). The final diagnosis from the multidisciplinary team was simultaneous liver and pancreatic MPMs. The patient returned to his local hospital for neoadjuvant chemotherapy and surgery, and he is still alive during the 6-mo postoperative follow-up.

CONCLUSION

Although rare, MPMs should be considered when treating pancreatic mass with suspected metastatic lesions, and EUS-FNA has proved minimally invasive and accurate.

Keywords: Multiple primary malignancies; Endoscopic ultrasound; Fine-needle aspiration; Pancreatic cancer; Liver cancer; Case report

Core Tip: We report a rare case of synchronous multiple primary liver and pancreatic malignancies confirmed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), although this patient was first diagnosed as having primary pancreatic cancer with multiple liver metastases by computed tomography and positron-emission tomography/computed tomography. Although rare, multiple primary malignancies should be considered in patients with pancreatic mass and suspected metastatic lesions, and EUS-FNA has proven to be a minimally invasive and accurate preoperative diagnosis method.