Metastatic lymph node impostor in pancreatic cystadenocarcinoma

Area of Science:

• Gastroenterology
• Oncology
• Pathology

Background:

• Lymph node metastasis in pancreatic cancer significantly predicts poor patient survival.
• Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is used to detect metastatic peri-pancreatic nodes, potentially altering surgical plans.
• Accurate staging is critical for determining curative resection eligibility in pancreatic cancer.

Observation:

• A case involving a patient with chronic lymphocytic leukemia (CLL) presented with a pancreatic solid-cystic lesion and suspicious peri-pancreatic lymphadenopathy on EUS.
• EUS-FNA revealed CLL involvement in the lymph nodes and elevated CEA in the cystic fluid.
• The absence of adenocarcinoma in the lymph nodes led to surgical intervention for the pancreatic lesion.

Findings:

• Pancreatic mucinous cystadenocarcinoma was diagnosed and surgically resected with clear margins.
• All 30 resected peri-pancreatic lymph nodes exclusively showed CLL involvement, not adenocarcinoma metastasis.
• This highlights that lymphadenopathy near pancreatic lesions may stem from systemic diseases rather than the pancreatic tumor itself.

Implications:

• Systemic lymphoproliferative disorders can present as metastatic adenocarcinoma on EUS, complicating diagnosis.
• EUS-FNA plays a vital role in differentiating lymphoproliferative diseases from metastatic cancer in peri-pancreatic lymph nodes.
• Accurate EUS-FNA diagnosis is essential for appropriate patient management and surgical planning in complex pancreatic cases.