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 Table of Contents  
IMAGES AND VIDEOS
Year : 2017  |  Volume : 6  |  Issue : 5  |  Page : 340-342

A rare case of pancreatic metastasis of angiosarcoma: Diagnosed by endoscopic ultrasound-guided fine-needle aspiration and biopsy


1 Department of Gastroenterology, Hepatology and Nutrition, UT MD Anderson Cancer Center, Houston, Texas, USA
2 Department of Pathology, UT MD Anderson Cancer Center, Houston, Texas, USA

Date of Submission07-Nov-2016
Date of Acceptance07-Nov-2016
Date of Web Publication16-Oct-2017

Correspondence Address:
Manoop S Bhutani
Department of Gastroenterology, Hepatology and Nutrition, Unit 1466, UT MD Anderson Cancer Center, 1515, Holcombe Blvd., 77030-4009, Houston, Texas
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.216719

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How to cite this article:
Bhutani MS, Arora A, Kundu U, Maru D. A rare case of pancreatic metastasis of angiosarcoma: Diagnosed by endoscopic ultrasound-guided fine-needle aspiration and biopsy. Endosc Ultrasound 2017;6:340-2

How to cite this URL:
Bhutani MS, Arora A, Kundu U, Maru D. A rare case of pancreatic metastasis of angiosarcoma: Diagnosed by endoscopic ultrasound-guided fine-needle aspiration and biopsy. Endosc Ultrasound [serial online] 2017 [cited 2019 Sep 18];6:340-2. Available from: http://www.eusjournal.com/text.asp?2017/6/5/340/216719



A 55-year-old female, with primary splenic angiosarcoma with metastatic lesions in liver, T-8 vertebra and left femur, status postsplenectomy, right hepatectomy and cholecystectomy, and multiple cycles of chemotherapy, was found to have a new 0.5 cm ill-defined attenuation focus in the body of pancreas on routine surveillance computed tomography (CT) scan. Follow-up of CT 2 months later revealed increase in size of the same mass to 0.8 cm [Figure 1], worrisome of progressive metastatic lesion from angiosarcoma. The patient was referred for endoscopic ultrasound (EUS)-guided fine-needle aspiration and biopsy (FNAB). On EUS [Figure 2], an 8 mm × 6 mm isoechoic rounded mass was seen in the pancreatic body. Transgastric EUS-guided fine-needle aspiration (two passes) and fine-needle core biopsy (two passes) were done using a 25 G, ProCore EUS needle (Cook). On cytology, specimens along with immunostains performed on the cell block sections showed that the neoplastic cells were positive for ERG and CD31 and focally/weakly positive for pan-cytokeratin. Immunohistochemical staining of the core biopsy revealed that the tumor cells were strongly positive for ERG (nuclear pattern), focally positive for CD31 and CD34, and negative for synaptophysin and chromogranin. This was consistent with metastatic angiosarcoma [Figure 3], [Figure 4], [Figure 5], [Figure 6].
Figure 1: Computed tomography scan showing (arrow) a small, 8 mm, subtle, ill-defined mass in the pancreatic body

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Figure 2: Endoscopic ultrasound exam revealing the same lesion (arrows) that was subjected to endoscopic ultrasound-guided fine-needle aspiration and core biopsy

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Figure 3: Papanicolaou-stained smear shows a group of spindled to epithelioid cells with coarse chromatin pattern consistent with the patient's history of angiosarcoma

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Figure 4: H and E stain of a cell block preparation demonstrates a small of groups of neoplastic spindle cells

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Figure 5: Immunohistochemistry performed on the cell block preparation shows positive staining for CD31, consistent with angiosarcoma

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Figure 6: Immunohistochemistry performed on the cell block preparation shows positive staining for ERG, consistent with angiosarcoma

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Angiosarcomas are rare, malignant, and frequently fatal soft tissue tumors and may metastasize to almost all visceral organs including pancreas. Definitive diagnosis can be made only with immunochemistry, and hence, obtaining biopsy is of paramount importance. EUS-FNAB has previously been described for diagnosing angiosarcoma in suprarenal gland [1] and spleen [2] in two prior case reports. To our knowledge, we present the first case of EUS-FNAB use for diagnosis of angiosarcoma within the pancreas. Primary angiosarcoma in pancreas may present as acute pancreatitis and diagnosis may be missed if biopsy is not performed as described by Csiszkó et al.[3] and Seth et al.[4] separately in their case reports. We recommend keeping angiosarcoma as a possible rare differential while evaluating pancreatic masses and using EUS-guided FNAB with these well-evaluated core needles[5],[6] to confirm the diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patients understand that her name and initial will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chen X, Lagana SM, Poneros J, et al. Cytological diagnosis of angiosarcoma arising in an immunosuppressed patient 6 years after multi-visceral transplantation: A case report and literature review. Diagn Cytopathol 2014;42:884-9.  Back to cited text no. 1
    
2.
Maeyashiki C, Nagata N, Uemura N. Angiosarcoma involving solid organs and the gastrointestinal tract with life-threatening bleeding. Case Rep Gastroenterol 2012;6:772-7.  Back to cited text no. 2
    
3.
Csiszkó A, László I, Palatka K, et al. Primary angiosarcoma of the pancreas mimicking severe acute pancreatitis – case report. Pancreatology 2015;15:84-7.  Back to cited text no. 3
    
4.
Seth AK, Argani P, Campbell KA. Angiosarcoma of the pancreas: Discussion of a rare epithelioid neoplasm. Pancreas 2008;37:230-1.  Back to cited text no. 4
    
5.
Berzosa M, Villa N, El-Serag HB, et al. Comparison of endoscopic ultrasound guided 22-gauge core needle with standard 25-gauge fine-needle aspiration for diagnosing solid pancreatic lesions. Endosc Ultrasound 2015;4:28-33.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Adler DG, Witt B, Chadwick B, et al. Pathologic evaluation of a new endoscopic ultrasound needle designed to obtain core tissue samples: A pilot study. Endosc Ultrasound 2016;5:178-83.  Back to cited text no. 6
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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