Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2021; 27(3): 294-304
Published online Jan 21, 2021. doi: 10.3748/wjg.v27.i3.294
Peritoneal dissemination of pancreatic cancer caused by endoscopic ultrasound-guided fine needle aspiration: A case report and literature review
Hideaki Kojima, Minoru Kitago, Eisuke Iwasaki, Yohei Masugi, Yohji Matsusaka, Hiroshi Yagi, Yuta Abe, Yasushi Hasegawa, Shutaro Hori, Masayuki Tanaka, Yutaka Nakano, Yusuke Takemura, Seiichiro Fukuhara, Yoshiyuki Ohara, Michiie Sakamoto, Shigeo Okuda, Yuko Kitagawa
Hideaki Kojima, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Yasushi Hasegawa, Shutaro Hori, Masayuki Tanaka, Yutaka Nakano, Yusuke Takemura, Yuko Kitagawa, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
Eisuke Iwasaki, Seiichiro Fukuhara, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
Yohei Masugi, Yoshiyuki Ohara, Michiie Sakamoto, Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan
Yohji Matsusaka, Shigeo Okuda, Department of Radiology, Keio University School of Medicine, Tokyo 160-8582, Japan
Author contributions: Kojima H interpreted the patient data based on the case notes and drafted the manuscript; Kitago M performed the surgery and supervised the manuscript; Masugi Y, Ohara Y, and Sakamoto M evaluated the pathological findings; all other members equally contributed to the medical treatment.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this case report and the accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The guidelines of the “CARE Checklist-2016: Information for writing a case report” have been adopted by the authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Minoru Kitago, PhD, Reader (Associate Professor), Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Received: December 5, 2020
Peer-review started: December 5, 2020
First decision: December 17, 2020
Revised: December 28, 2020
Accepted: January 6, 2021
Article in press: January 6, 2021
Published online: January 21, 2021

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and specificity. Although needle-tract seeding caused by EUS-FNA has been recently reported, dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient prognosis. However, the frequency of dissemination and needle-tract seeding appears to have been underestimated. We present a case of peritoneal dissemination of pancreatic cancer due to preoperative EUS-FNA.


An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical screening. Trans-gastric EUS-FNA revealed that the mass was an adenocarcinoma; hence laparoscopic distal pancreatectomy with lympha-denectomy was performed. No intraoperative peritoneal dissemination and liver metastasis were visually detected, and pelvic lavage cytology was negative for carcinoma cells. The postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin; however, pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site, and the cells were suspected to be disseminated via EUS- FNA. Hence, the patient received adjuvant therapy with S-1 (tegafur, gimeracil, and oteracil potassium); however, computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous peritonitis. The patient received palliative therapy and died 8 mo after the operation.


The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination, especially for cancers in the pancreatic body or tail.

Keywords: Case report, Pancreatic carcinoma, Endoscopic ultrasound-guided fine needle aspiration, Peritoneal dissemination, Cancerous peritonitis, Biopsy

Core Tip: Along with the development of preoperative chemotherapy, there is an increasing need for tissue sample collection using endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Peritoneal dissemination and needle-tract seeding caused by EUS-FNA were previously considered rare events with minimal prognostic impact. However, we experienced a case of peritoneal dissemination of pancreatic cancer—secondary to EUS-FNA—that markedly affected postoperative survival. We provide suggestions for the use of EUS-FNA along with a review of literature.