title: Endoscopic ultrasound fine-needle aspiration detection of extravascular migratory metastasis from a remotely located pancreatic cancer.
abstract: OBJECTIVE
  Tumor cell migration along the periphery of blood vessels to remote sites has been termed extravascular migratory metastasis, which is distinct from direct gross tumor infiltration of blood vessels and from intravascular dissemination. Our objective was to report the presence of malignant perivascular cuffing of the celiac axis in a patient with an apparently early T stage and resectable pancreatic cancer.
  
  
  METHODS
  Case report is presented.
  
  
  RESULTS
  Endoscopic ultrasound (EUS) examination was performed with targeted fine-needle aspiration (FNA) of previously unrecognized perivascular cuffing by computed tomography, which established the presence of celiac axis malignant perivascular cuffing in the setting of a T1 pancreatic cancer.
  
  
  CONCLUSIONS
  EUS FNA might allow identification and tissue confirmation of otherwise unrecognized extravascular migratory metastasis. This finding suggests the potential for EUS FNA to further improve pancreatic cancer staging and to enhance patient care and outcomes.
authors.affiliation: Fiterman Centre for Digestive Disease, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, Minnesota 55905, USA. levy.michael@mayo.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Ferga C
authors.initials: FC
authors.lastname: Gleeson
authors.forename: Lizhi
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000818:Animals; D044963:Biopsy, Fine-Needle; D002445:Celiac Artery / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000556:secondary* / Q000601:surgery