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Title: |
Isolated Pancreatic Metastasis of Uterine Leiomyosarcoma Diagnosed by Fine Needle Aspiration Biopsy | |||||||||||||||||||
| Authors: | Lazaros Skagias, M.D., Evangelou Ioulia, M.D., and Ekaterini Politi, M.D., Ph.D. | |||||||||||||||||||
| To the Editors: Utilizing fine needle aspiration (FNA) biopsy in pancreas diagnostics, it is inevitable that cytopathologists will encounter rare types of metastatic tumors in their practice. Uterine leiomyosarcomas (LMS) comprise only 1% of all uterine malignancies. They are aggressive neoplasms with a propensity for local recurrence and high incidence of metastatic disease. Pelvic and paraaortic lymph node involvement is prospective. Lung and liver are common sites of distant metastasis.1 The usual time of recurrence is between the second and fifth year after the initial diagnosis.1 Isolated pancreatic metastasis from uterine LMS 10 years after hysterectomy without widespread metastatic disease is an extremely uncommon situation. The literature was reviewed, confirming the rarity of such a presentation and the novelty of this case. Only 2 similar cases have been reported to date.2,3 A 68-year-old woman underwent hysterectomy for high grade LMS 10 years earlier. In this period the patient was in good health, without evidence of recurrence or metastasis. The latest routine follow-up abdominal computed tomography scan demonstrated a pancreatic mass measuring nearly 4.5 cm in diameter. Fine needle aspiration biopsy under computed tomography guidance was performed. Alcohol-fixed and air-dried smears were prepared for Papanicolaou and Giemsa stains, as well as ThinPrep (Cytyc Corporation, West Sussex, U.K.) slides. Aspiration yielded a highly cellular specimen composed mostly of spindle-shaped cells aligned in parallel fascicles. The cells had indistinct contours and elongated, cigar-shaped, blunt-ended nuclei arranged in parallel arrays along with moderate amounts of cytoplasm (Figure 1). A dissociation pattern with individual cells and stripped nuclei was also seen, but the cohesive cells predominated. Fibrotic connective tissue fragments and a little necrotic debris were observed in the background. | ||||||||||||||||||||
| Keywords: | aspiration biopsy, fine-needle; leiomyosarcoma; pancreatic cancer; uterine cancer | |||||||||||||||||||
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