Desmoid Fibromatosis of the Gastric Wall Mimicking Needle Tract Seeding after Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Pancreatic Cancer: A Case Report.
When lesions appear along the EUS-FNB puncture tract, clinicians should consider alternative diagnoses like desmoid fibromatosis, not just needle tract seeding.
Where it sits
this study against the rest of the sermorelin corpusSummary and findings
A case report describes a woman in her 70s who developed a 30-mm submucosal tumor in the stomach two years after undergoing EUS-FNB for pancreatic adenocarcinoma. The tumor was initially suspected to be needle tract seeding but was later diagnosed as desmoid fibromatosis following partial gastrectomy and histopathological analysis. This highlights the importance of considering alternative diagnoses when lesions appear along the EUS-FNB puncture tract.
Abstract
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is widely used for the pathological diagnosis of pancreatic diseases. However, needle tract seeding (NTS) remains a clinical concern, particularly when the puncture route is not included in the surgical resection field. We report a case in which distinguishing NTS from other pathologies was challenging. A woman in her 70s underwent EUS-FNB via the gastric antrum for a 10-mm pancreatic head lesion, which was diagnosed as adenocarcinoma (cT1bN0M0, Stage IA). She subsequently underwent pancreaticoduodenectomy (pT3N0M0, Stage IIA) without adjuvant chemotherapy. Two years postoperatively, a 30-mm submucosal tumor was detected in the stomach. Although positron emission tomography-computed tomography demonstrated fluorodeoxyglucose uptake, three separate sessions of EUS-FNB failed to yield a definitive diagnosis, with NTS being strongly suspected. Partial gastrectomy was performed. Histopathology revealed a fascicular proliferation of spindle-shaped cells with nuclear β-catenin positivity, leading to the diagnosis of a desmoid fibromatosis (DF). This case underscores that although NTS should be considered when a lesion arises along the EUS-FNB puncture tract, alternative diagnoses, including DF, must also be carefully evaluated.
Background
The study addresses the diagnostic challenges associated with needle tract seeding (NTS) following endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for pancreatic cancer. NTS is a concern when the puncture route is not included in the surgical resection field. This case report is significant as it highlights the potential for misdiagnosis between NTS and other pathologies such as desmoid fibromatosis.
Methods
This is a case report involving a woman in her 70s who underwent EUS-FNB for a 10-mm pancreatic head lesion, diagnosed as adenocarcinoma. The patient later developed a 30-mm submucosal tumor in the stomach, which was evaluated through three EUS-FNB sessions and ultimately required partial gastrectomy for definitive diagnosis.
Results
The primary finding was the detection of a 30-mm submucosal tumor in the stomach two years after the initial EUS-FNB. Despite multiple EUS-FNB attempts, a definitive diagnosis was not achieved until partial gastrectomy was performed. Histopathological analysis revealed desmoid fibromatosis, characterized by fascicular proliferation of spindle-shaped cells with nuclear β-catenin positivity.
Interpretation
This case illustrates the diagnostic complexity in distinguishing NTS from other pathologies such as desmoid fibromatosis. While NTS is a known risk following EUS-FNB, this report emphasizes the need for thorough evaluation of alternative diagnoses. The findings are consistent with prior literature on the challenges of diagnosing submucosal tumors post-EUS-FNB, but the clinical significance is limited by the single-case nature.
Key findings
- A 30-mm submucosal tumor was detected in the stomach two years postoperatively.
- Three EUS-FNB sessions failed to yield a definitive diagnosis.
- Histopathology revealed fascicular proliferation of spindle-shaped cells with nuclear β-catenin positivity.
- The final diagnosis was desmoid fibromatosis.
Limitations
- Single case report limits generalizability.
- Observational and descriptive findings.
- No broader statistical analysis.
- Diagnosis required invasive partial gastrectomy.