Cutaneous seeding of pancreatic carcinoma by fine-needle aspiration biopsy

Ultrasound-guided percutaneous fine-needle aspiration biopsy of the pancreas is a safe and accurate technique. We report the third case of cutaneous needle-track seeding of pancreatic carcinoma. A 68-year-old woman presented in April 1984 with a 1-month history of obstructive jaundice, abdominal discomfort and weight loss. Ultrasound examination showed a distended biliary tree above a 3 cm mass in the pancreatic head. Fineneedle aspiration biopsy was performed using two passes with a 22-gauge needle. Cytology of the aspirated material showed normal ductal cells only. Two further attempts to obtain cytology were performed: in the first, five passes with a 22- gauge needle and a core biopsy with a 19-gauge Otto needle were made; in the second, three passes with a 22-gauge needle were made. In neither was there any evidence of malignancy. A presumptive diagnosis of carcinoma of the pancreas was made and an 8-gauge biliary endoprosthesis was inserted endoscopically. Her jaundice quickly resolved. She presented again in October 1984 with a short history of gastric outlet obstruction. On examination she had a 1.1 cm × 0.7 cm cutaneous nodule in the epigastrium (Fig. 1). Ultrasound and barium studies showed compression of the second part of the duodenum by a large tumour mass. Laparotomy was performed; there were multiple peritoneal seedlings and a large tumour mass in the head of the pancreas. A choledochoduodenostomy and gastrojejunostomy were performed. Histology obtained from the pancreatic mass, a peritoneal deposit and the skin nodule showed poorly differentiated adenocarcinoma.