Needle Tract Seeding Following Transgastric Endoscopic Ultrasound-Fine Needle Aspiration for Pancreatic Tail Cancer:...

We report the case of a 69-year-old man with a branch-duct intraductal papillary mucinous neoplasm who underwent surveillance endoscopic ultrasound (EUS), which revealed a 15 mm hypoechoic mass in the pancreatic tail. Transgastric EUS-guided fine needle aspiration (FNA) confirmed a diagnosis of resectable pancreatic ductal adenocarcinoma. After neoadjuvant chemotherapy, the patient underwent laparoscopic distal pancreatectomy. Twelve months later, contrast-enhanced computed tomography demonstrated a 20 mm mass lesion in the gastric body. Esophagogastroduodenoscopy showed a submucosal tumor-like lesion, and endoscopic biopsy from the lesion confirmed adenocarcinoma. Laparoscopic local gastric resection was performed, and needle tract seeding (NTS) was diagnosed based on clinical and histopathological findings. Four months after gastric surgery, peritoneal dissemination was suspected, and chemotherapy with gemcitabine plus nab-paclitaxel was initiated. This case highlights the risk of NTS after transgastric EUS-FNA and underscores the importance of careful postoperative surveillance.