Diagnosis of a metastatic phyllodes tumor of the pancreas using EUS-FNA.
BACKGROUND
Phyllodes tumors are rare fibro-epithelial lesions which make up less than 1% of all breast neoplasms. After curative surgery, distant metastases may occur without local recurrence; the typical sites of the metastases being the lungs and the bones. Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (EUS-FNA) has emerged as the leading modalities for the evaluation of pancreatic masses. Until now, there have been no published reports on the use of EUS-FNA to diagnose recurrent phyllodes tumors metastatic to the pancreas.


METHODS
A 55-year-old female was hospitalized for the problem of painless obstructive jaundice due to a pancreatic head mass causing biliary obstruction. She had a past history of a left breast phyllodes tumor treated with mastectomy. The diagnostic dilemma was whether this was a case of primary pancreatic cancer or a recurrent phyllodes tumor presenting as a pancreatic metastasis. EUS-FNA of the mass was performed and it revealed a metastatic phyllodes tumor. The patient was treated with palliative biliary stenting and was referred for palliative chemotherapy.


CONCLUSIONS
This is the first report of a recurrent phyllodes tumor metastatic to the pancreas diagnosed using EUS-FNA. It highlights the utility of EUS-FNA in characterizing the nature of pancreatic head masses.
Ang
Tiing Leong
TL
Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore, Singapore. tiing_leong_ang@cgh.com.sg
Ng
Victor Weng Leong
VW
Fock
Kwong Ming
KM
Teo
Eng Kiong
EK
Chong
Chee Keong
CK
D044963:Biopsy, Fine-Needle / Q000379:methods; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000556:secondary*; D003557:Phyllodes Tumor / Q000175:diagnosis / Q000556:secondary*