P1792 - Utilizing Endoscopic Ultrasound With Fine-Needle Biopsy For Unusual Pancreatic Metastasis: Two Cases Of Neuroendocrine Transformation From Primary Prostate Cancer
University of Wisconsin Hospitals and Clinics Madison, WI
Oscar A. Ramirez Ramirez, MD1, Dana A. Ley, MD1, Eric Vecchio, MD1, Kristina A. Matkowskyj, MD, PhD1, Rashmi M. Agni, MD1, Douglas McNeel, MD, PhD, MS1, Joshua M. Lang, MD2, Deepak V. Gopal, MD, FACG1 1University of Wisconsin Hospitals and Clinics, Madison, WI; 2University of Wisconsin, Madison, WI
Introduction: Metastatic cancer to the pancreas is rare and lesions from prostate cancer (PC) are exceptionally uncommon, with about 10 cases reported in the literature. We present 2 cases of metastatic PC exhibiting high-grade neuroendocrine transformation involving the pancreas.
Case Description/Methods: A 62-year-old male with metastatic PC presented with obstructive jaundice and 10lb weight loss. Labs were notable for direct bilirubin 9.3, ALK P 646, PSA 13, CA 19-9 1003. CT demonstrated infiltrative pancreatic lesions, largest in the pancreatic head causing intra and extrahepatic biliary ductal dilation. Enlargement of prostate with concern for infiltration into the retro-prostatic space was also identified. ERCP revealed a single severe distal common bile duct (CBD) stricture with proximal dilation to 12mm. Biliary sphincterotomy, CBD dilation with biliary stenting were performed. Endoscopic ultrasound (EUS) with fine needle biopsies (FNB) were obtained. The neoplastic cells expressed pancytokeratin AE1/AE3, neuroendocrine markers synaptophysin and INSM1, and high Ki67 index. Morphologic and immunohistochemical findings were consistent with metastatic large cell neuroendocrine carcinoma arising from the prostate.
Our second case is a 71-year-old male with metastatic PC with prior stable disease who presented with fatigue, 10lb weight loss and pelvic pressure. CT revealed a new pelvic mass originating from the prostate with invasion into the rectum and a new pancreatic tail mass. EUS demonstrated a round hypoechoic, heterogenous mass of 12 x 7mm with well-defined borders. Rectal ultrasound (RUS) identified an iso-hypoechoic, heterogenous 6 cm x 8 cm mass in the anterior perirectal space with poorly defined borders. FNB of both lesions were obtained. The neoplastic cells were positive for synaptophysin and chromogranin but were negative for the prostatic marker NKX3.1. The morphologic features in conjunction with the immunoprofile were consistent with neuroendocrine transformation of the patient's prior prostatic carcinoma to a small cell carcinoma.
Discussion: As a result of prolonged survival of patients with PC, there has been an increase in secondary occurrence. EUS-FNB plays a crucial role in diagnosing unusual cases like small cell-neuroendocrine transformation metastatic to the pancreas from primary prostate cancer. There are no specific therapy guidelines available, and treatment is centered on a palliative intention from a multidisciplinary group's guidance.
Figure: Figure 1: EUS and histology images from Metastatic neuroendocrine carcinoma to the pancreas. (A) EUS showing 12 x 7 mm hypoechoic mass in the pancreatic tail with well-defined borders. (B) lower endoscopic ultrasound with a 6.6 x 8 cm iso-hypoechoic heterogeneous large mass in the anterior perirectal space, with poorly defined borders. (C) High-grade tumor abutting a pancreatic islet (islet highlighted by orange arrow) with neoplastic cells exhibiting nuclear hyperchromasia along with nuclear molding, readily identified mitotic figures and some karyorrhectic debris.
Disclosures:
Oscar Ramirez Ramirez indicated no relevant financial relationships.
Dana Ley indicated no relevant financial relationships.
Eric Vecchio indicated no relevant financial relationships.
Kristina Matkowskyj indicated no relevant financial relationships.
Rashmi Agni indicated no relevant financial relationships.
Douglas McNeel indicated no relevant financial relationships.
Joshua Lang indicated no relevant financial relationships.
Deepak Gopal indicated no relevant financial relationships.
Oscar A. Ramirez Ramirez, MD1, Dana A. Ley, MD1, Eric Vecchio, MD1, Kristina A. Matkowskyj, MD, PhD1, Rashmi M. Agni, MD1, Douglas McNeel, MD, PhD, MS1, Joshua M. Lang, MD2, Deepak V. Gopal, MD, FACG1. P1792 - Utilizing Endoscopic Ultrasound With Fine-Needle Biopsy For Unusual Pancreatic Metastasis: Two Cases Of Neuroendocrine Transformation From Primary Prostate Cancer, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
