A Case of Needle Tract Implantation after Ultrasonically Guided Aspiration Cytology of Mucinous Cystadenocarcinoma of the Pancreas

Setsujo Shiota, Michimasa Ueda, Makoto Mizuta, Toshiya Wamata, Hiroshi Hiraoka, Yohsuke Miyano, Noritake Iwai, Hisashi Tani

Department of Surgery, Yoka Hospital

We report a case thought to be a needle tract implantation after ultrasonically guided aspiration cytology for mucinous cystadenocarcinoma of the pancreas. A 68-year-old man was referred to our hospital because of a high serum amylase level detected in a mass examination. As abdominal US and CT revealed a small cystic lesion at the head of the pancreas, ultrasonically guided aspiration cytology was performed. The aspirates showed papillary adenocarcinoma cell clusters under the mucinous background. Thus we diagnosed mucinous cystadenocarcinoma of the pancreas. Pancreatoduodenectomy was performed. A year later abdominal US revealed hypoechoic mass in the abdominal wall at the epigastrium. About 2 years later, a thumb sized subcutaneous tumor was recognized at the epigastrium, the same site where the previous aspiration cytology was done. Aspiration cytology of this subcutaneous tumor disclosed adenocarcinoma cells with much mucin in the cytoplasma. We diagnosed the nodule as metastatic tumor of the abdominal wall. A second look operation was done. There were no signs of recurrence in the peritoneal cavity, and the metastatic tumor was excised. Histological examination of the tumor showed metastatic papillary adenocarcinoma similar to the previous pancreatic cancer. Therefore we considered this metastatic tumor of the abdominal wall a needle tract implantation after ultrasonically guided aspiration cytology for mucinous cystadenocarcinoma of the pancreas. We suggest that the occurrence of needle tract implantation should be expected in fine needle aspiration cytology. We should determine the indications for aspiration cytology of pancreatic cancers and follow them carefully.

Key words
needle tract implantation, ultrasonically guided aspiration cytology, mucinous cystadenocarcinoma of the pancreas

Reprint requests
Setsujo Shoita Department of Surgery, Yoka Hospital
1878-1 Yoka, Yabugun, 667 JAPAN

Accepted
March 8, 1995

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