CASE REPORT

JOP. J Pancreas (Online) 2005; 6(2):189-193.

Metastatic Lymph Node Impostor in Pancreatic Cystadenocarcinoma

Charles KF Vu1, Fuju Chang2, Laura Doig1, John Meenan1

1Department of Gastroenterology, and 2Department of Histopathology, Guy’s and St Thomas’ Hospitals. London, United Kingdom

ABSTRACT

Context Lymph node involvement in pancreatic cancer is a predictor of poor patient long-term survival. The detection of multiple metastatic peri-pancreatic nodes by EUS-FNA may dissuade the surgeon from undertaking a curative pancreatic resection.

Case report We report an interesting case of a man with chronic lymphocytic leukemia, who presented with the diagnostic problem of a pancreatic solid-cystic lesion and multiple malignant-looking peri-pancreatic lymphadenopathy on EUS. EUS-FNA yielded chronic lymphocytic leukaemia involvement in the peri-pancreatic lymph nodes and a markedly elevated CEA in the cystic fluid. The absence of adenocarcinoma involvement of the lymph nodes prompted surgery on the pancreatic lesion with a curative intent. Pancreatic mucinous cystadenocarcinoma was diagnosed and a sub-total pancreatectomy was performed with clear resection margins. All 30 resected peri-pancreatic lymph nodes showed chronic lymphocytic leukemia involvement only.

Conclusions This case illustrates that abnormal lymphadenopathy adjacent to a primary pancreatic lesion may not necessarily be due to the latter. Systemic lymphoproliferative disease, as in this case, can masquerade as metastatic adenocarcinoma lymph nodes on EUS. EUS-FNA is useful in diagnosing lymphoproliferative disease.

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Keywords Biopsy, Fine-Needle; Cystadenocarcinoma; Cystadenocarcinoma, Mucinous; Endosonography; Leukemia, Lymphatic Diseases; Lymphocytic, Chronic; Pancreas

Correspondence John Meenan: john.meenan@gstt.sthames.nhs.uk