title: Primary pancreatic leiomyosarcoma with metastasis to the liver diagnosed by endoscopic ultrasound-guided fine needle aspiration and fine needle biopsy: A Case Report and Review of Literature.
abstract: Primary pancreatic leiomyosarcomas are rare tumors of the pancreas that are usually diagnosed after resection or by biopsy. One case in the literature has utilized endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology. We report a second case of a primary pancreatic leiomyosarcoma that yielded diagnostic material on EUS-FNA cytology. A 72-year-old female presented with 3-4 months of abdominal pain. A CT scan showed a large heterogeneous, lobulated pancreatic head and uncinate mass and multiple hypoattenuating liver lesions. An EUS-FNA was performed on one of the liver lesions with a 25-gauge needle, yielding an adequate sample with lesional cells. The initial read was a spindle cell neoplasm. A subsequent endoscopic ultrasound-guided fine needle biopsy with a 22-gauge needle was performed on the pancreatic head mass to rule out two primaries and to provide tissue for a mitotic index in the case of gastrointestinal tumor. Both the cell block of the EUS-FNA and the core biopsy were equally cellular and showed interlacing spindle cells that stained positive for SMA and negative for DOG-1, CD 117, and CD34. In addition, the core biopsy of the pancreas stained positive for Desmin. A diagnosis of a primary pancreatic leiomyosarcoma was made and the patient was started on systemic chemotherapy. Primary pancreatic leiomyosarcomas are rare pancreatic tumors that may yield diagnostic material by EUS-FNA with a 25-gauge needle. Diagn. Cytopathol. 2016;44:1070-1073. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York, 14263.
authors.forename: Maria Cecilia D
authors.initials: MC
authors.lastname: Reyes
authors.affiliation: Department of Pathology, George Washington University, Washington, DC.
authors.forename: Xiao
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York, 14263.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bain
authors.affiliation: Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York, 14263.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Ylagan
mesh_terms: D000368:Aged; D000075369:Anoctamin-1; D018952:Antigens, CD34 / Q000235:genetics / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D018118:Chloride Channels / Q000235:genetics / Q000378:metabolism; D003893:Desmin / Q000235:genetics / Q000378:metabolism; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000378:metabolism / Q000473:pathology*; D008113:Liver Neoplasms / Q000556:secondary*; D009363:Neoplasm Proteins / Q000235:genetics / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000473:pathology*; D019009:Proto-Oncogene Proteins c-kit / Q000235:genetics / Q000378:metabolism
chemical_list: C476213:ANO1 protein, human; D000075369:Anoctamin-1; D018952:Antigens, CD34; D014408:Biomarkers, Tumor; D018118:Chloride Channels; D003893:Desmin; D009363:Neoplasm Proteins; D019009:Proto-Oncogene Proteins c-kit
keywords: cytology; diagnostic yield; endoscopic ultrasound-guided fine needle aspiration; primary pancreatic leiomyosarcoma