Metastatic tumors to the pancreas: Balancing clinical impression with cytology findings
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Updated: Oct 3, 2025
DIPLOMA Approach for Standardized Pathology Assessment of Distal Pancreatectomy Specimens
Published on: February 1, 2020
Mohamed A Abdallah1, Kimberlee Bohy2, Ashwani Singal1
1Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States.
Backgrounds/Aims:
Metastatic lesions of the pancreas (PMET) account for 1%-5% of all malignant solid pancreatic lesions (SPL). In this study we evaluated the utility of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) in diagnosing PMET.
Methods:
Patients who underwent EUS-FNA at a community referral center between 2011-2017 for SPL were identified. Clinical, radiologic, and EUS-FNA features of those with PMET were compared to those with primary solid tumors of the pancreas: pancreatic adenocarcinoma (PDAC) and neuroendocrine tumors (PNET).
Results:
A total of 191 patients were diagnosed with solid pancreatic malignancy using EUS-FNA: 156 PDAC, 27 PNET, and eight (4.2%) had PMET. Patients with PMET were less likely to have abdominal pain (25.0% vs. 76.3% vs. 48.2%; p < 0.01) or obstructive jaundice (37.5% vs. 58.3% vs. 0%; p < 0.01) compared to PDAC and PNET. Those with PMET were more likely to have mass lesions with/without biliary or pancreatic ductal dilatations (100% vs. 86.5% vs. 85.2%; p < 0.01) and lower CA19-9 (82.5 ± 43.21 U/mL vs. 4,639.30 ± 11,489.68 U/mL vs. 10.50 ± 10.89 U/mL; p < 0.01) compared to PDAC and PNET. Endosonographic features were similar among all groups. Seven (87.5%) patients with PMET had a personal history of malignancy prior to PMET diagnosis. The primary malignancy was renal cell carcinoma in five PMET.
Conclusions:
PMET are exceedingly rare, comprising less than 5% of SLP. Patients with PMET are less likely to present with symptoms and mostly identified by surveillance imaging for the primary malignancy.
Insights
Metastatic pancreatic lesions (PMET) are rare, accounting for less than 5% of solid pancreatic lesions. Endoscopic ultrasonography with fine needle aspiration (EUS-FNA) aids in their diagnosis, often revealing patients without typical symptoms.
Area of Science:
- Gastroenterology
- Oncology
- Diagnostic Imaging
Background:
- Metastatic lesions of the pancreas (PMET) represent a small fraction (1%-5%) of all malignant solid pancreatic lesions (SPL).
- Distinguishing PMET from primary pancreatic tumors is crucial for accurate diagnosis and treatment planning.
Purpose of the Study:
- To evaluate the diagnostic utility of endoscopic ultrasonography with fine needle aspiration (EUS-FNA) for metastatic lesions of the pancreas (PMET).
- To compare the clinical, radiologic, and EUS-FNA features of PMET with primary pancreatic adenocarcinoma (PDAC) and neuroendocrine tumors (PNET).
Main Methods:
- Retrospective review of patients undergoing EUS-FNA for SPL between 2011-2017 at a community referral center.
- Comparison of clinical, radiologic, and EUS-FNA characteristics between PMET, PDAC, and PNET groups.
Main Results:
- EUS-FNA diagnosed 8 (4.2%) PMET among 191 solid pancreatic malignancies.
- PMET patients presented less frequently with abdominal pain or jaundice and had lower CA19-9 levels compared to PDAC and PNET.
- A history of prior malignancy was present in 87.5% of PMET cases, with renal cell carcinoma being the most common primary tumor.
Conclusions:
- Metastatic lesions of the pancreas are rare and often present with atypical symptoms.
- EUS-FNA is a valuable tool for diagnosing PMET, which are frequently identified during surveillance for other malignancies.
