Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration: A case report and literature review

Hideaki Kojima, Minoru Kitago, Eisuke Iwasaki, Yohei Masugi, Yohji Matsusaka, Hiroshi Yagi, Yuta Abe, Yasushi Hasegawa, Shutaro Hori, Masayuki Tanaka, Yutaka Nakano, Yusuke Takemura, Seiichiro Fukuhara, Yoshiyuki Ohara, Michiie Sakamoto, Shigeo Okuda, Yuko Kitagawa

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)


BACKGROUND Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and specificity. Although needle-tract seeding caused by EUS-FNA has been recently reported, dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient prognosis. However, the frequency of dissemination and needle-tract seeding appears to have been underestimated. We present a case of peritoneal dissemination of pancreatic cancer due to preoperative EUS-FNA. CASE SUMMARY An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical screening. Trans-gastric EUS-FNA revealed that the mass was an adenocarcinoma; hence laparoscopic distal pancreatectomy with lymphadenectomy was performed. No intraoperative peritoneal dissemination and liver metastasis were visually detected, and pelvic lavage cytology was negative for carcinoma cells. The postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin; however, pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site, and the cells were suspected to be disseminated via EUS-FNA. Hence, the patient received adjuvant therapy with S-1 (tegafur, gimeracil, and oteracil potassium); however, computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous peritonitis. The patient received palliative therapy and died 8 mo after the operation. CONCLUSION The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination, especially for cancers in the pancreatic body or tail.

Original languageEnglish
Pages (from-to)294-304
Number of pages11
JournalWorld Journal of Gastroenterology
Issue number3
Publication statusPublished - 2021 Jan 21


  • Biopsy
  • Cancerous peritonitis
  • Case report
  • Endoscopic ultrasound-guided fine needle aspiration
  • Pancreatic carcinoma
  • Peritoneal dissemination

ASJC Scopus subject areas

  • Gastroenterology


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