Case of pancreatic metastasis from colon cancer in which cell block using the Trefle® endoscopic scraper enables differential diagnosis from pancreatic cancer

Figure 1 Imaging findings and samples obtained using the Trefle^® device. A and B: Abdominal computed tomography indicated a poorly enhanced region (yellow arrowhead), dilated common bile duct (blue arrow), and upstream main pancreatic duct (orange arrow); C: Endoscopic retrograde cholangiopancreatology demonstrated a biliary stricture; D: The Trefle^® device was inserted and opened, and the scraping loops were identified under fluoroscopic guidance (yellow arrow); E: Appearance of the Trefle^® device; F: Appearance of samples obtained; G and H: Appearance of the centrifuged deposit.

Figure 2 Histological findings. Immunohistochemical staining revealed that cancer cells in cell block specimens obtained using the Trefle^® device were focally positive for cytokeratin 7 (CK 7), and positive for CK 20 and caudal type homeobox 2 (CDX 2). These findings were consistent with those of rectal resection specimens.