Endoscopy 2018; 50(04): S198
DOI: 10.1055/s-0038-1637651
ESGE Days 2018 ePosters
Georg Thieme Verlag KG Stuttgart · New York

DIGITAL PANCREATOSCOPY- DIRECTED DIAGNOSIS OF UNEXPECTED METASTASIS IN THE PANCREAS FROM FIBROMYXOID SARCOMA – A CASE REPORT

P Karagyozov
1   Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
I Boeva
1   Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
I Tishkov
1   Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
V Mitova
1   Interventional Gastroenterology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
,
K Draganov
2   General Surgery, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aim:

We report a case of digital pancreatoscopy with endoscopic evaluation, biopsy and histological verification of metastasis from fibromyxoid sarcoma in the pancreas.

Method:

A 72-year old woman was referred to our hospital with MRT scan showing a 4 cm cystic- appearing lesion in the pancreas defined as pseudocyst, elevation of cholestatic liver enzymes and abdominal pain. She had a history of vulvar myxoid sarcoma, resected 2 years ago, as well as of cervical carcinoma 30 years ago. Abdominal ultrasound and CT-scan demonstrated 4 × 3 cm well circumscribed lesion in the head of pancreas with mass effect, translating in dilatation of main pancreatic duct and common bile duct. Our initial work- up included biliary and pancreatic stenting (plastic stents) and histological examination. The pathology result was inconclusive. Due to persistent suspicion of malignancy the patient was scheduled for peroral pancreatoscopy. The intraductal images demonstrated lesion throughout the main pancreatic duct consistent with malignant infiltration. Pancreatoscopy-guided biopsies were taken with histology demonstrating spindle cell tumor. Comprehensive and immunohistochemical stainings, and pathological comparison with previous vulvar malignancy concluded a metastasis or metachronous focus of fibromyxoid sarcoma. Cholangioscopy was performed showing a compression of the distal CBD and artefacts due to previous stenting.

Results:

The patient was referred to oncology unit. Staging PET-CT was planned and the potential option for duodenopancreatic resection or palliative radiochemotherapy will be discussed on a tumor board.

Conclusion:

Despite efforts in defining pancreatic cystic-appearing lesion, diagnostic difficulty still remains, so alternative endoscopic modalities are needed. SpyGlass pancreatoscopy is a useful tool for difficult diagnostic cases mainly because of the opportunity of direct endoscopic visualization and tissue sampling.