title: Pancreatic metastasis of an ovarian malignant mixed Mullerian tumor identified by EUS-guided fine needle aspiration and Trucut needle biopsy.
abstract: BACKGROUND
  Malignant mixed Mullerian tumors are rare ovarian neoplasms that account for less than 2% of ovarian malignancies. They have a generally poor prognosis and often develop recurrent disease. To our knowledge, this is the first report of a malignant mixed Mullerian tumor with metastasis to the pancreas. The metastatic tumor was identified by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) and Trucut needle biopsy of the pancreas.
  
  
  METHODS
  We describe a 69-year-old female with concomitant Duke's C adenocarcinoma of the colon and stage III-C malignant mixed Mullerian tumor that presented with malignant ascites, increasing abdominal girth and a pancreatic head mass. EUS revealed an 11 cm cystic mass in the head of the pancreas that was characterized as a carcinosarcoma/malignant mesodermal mixed tumor by EUS-FNA and Trucut needle biopsy. The tumor was morphologically identical to the surgical specimen of her ovarian mass. The patient was treated with palliative chemotherapy and a three-month follow up CT scan did not reveal any new metastatic lesions.
  
  
  CONCLUSIONS
  The pancreas is a rare site of metastasis and more commonly seen in renal cell carcinoma, melanoma or lung tumors; amongst others. Although ovarian adenocarcinoma has been reported as a primary site of pancreatic metastasis, it has not been previously described originating from a mixed Mullerian tumor of the ovary presenting as a cystic pancreatic head mass.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. rogelio-silva@uiowa.edu
authors.forename: Rogelio G
authors.initials: RG
authors.lastname: Silva
authors.forename: Laila
authors.initials: L
authors.lastname: Dahmoush
authors.forename: Henning
authors.initials: H
authors.lastname: Gerke
mesh_terms: D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D019160:Endosonography; D005260:Female; D006801:Humans; D018200:Mixed Tumor, Mullerian / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000473:pathology*; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D011379:Prognosis; D014057:Tomography, X-Ray Computed