Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Diagnosis of Pancreatic Metastases Secondary to Ovarian Carcinoma

Solitary Pancreatic Metastasis from an Ovarian Carcinoma: A Diagnostic Perplexity

Ovarian cancer presenting as an isolated pancreatic metastasis after years of treatment is extremely rare. Most such patients are easily misdiagnosed as a case of primary pancreatic cancer. We herein describe a unique case of posttreatment high-grade serous papillary ovarian carcinoma metastasizing to the pancreas that mimicked primary pancreatic cancer and caused a diagnostic dilemma. The approach to such a case, pathogenesis, differential diagnosis, management, and a brief literature review is also presented.

Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer

Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.

Primary Peritoneal Carcinosarcoma With Metastasis to the Umbilicus and Pancreas

A 51-year-old woman visited our hospital after being diagnosed with ascites effusion by her previous physician due to weight gain for 6 months. Ascites cytology showed adenocarcinoma, MRI showed an omental cake, and CT showed neoplastic lesions in the umbilicus and pancreas. Laparoscopy revealed that the omentum had been replaced by a tumor. Biopsies of the omentum and umbilicus revealed a carcinosarcoma. Treatment with paclitaxel and carboplatin was unsuccessful, and the patient's general condition deteriorated, leading to her demise. Pathological autopsy revealed carcinosarcoma of peritoneal origin metastasizing to the umbilicus and tail of the pancreas. No tumors were found in the uterus, ovaries, or fallopian tubes.