P0072 - The Case Report of Sarcoma Metastasis to the Pancreas, a Rare Metastatic Tumor of the Pancreas

Anila Mahesh, MBBS¹, Deepak Kumar, MBBS², Manisha Devi, MBBS¹, Kishore Kumar, MD^3
1Ziauddin Medical University, Karachi, Sindh, Pakistan; ²Sindh Medical College, Karachi, Sindh, Pakistan; ³Banner Desert Medical Center, Chandler, AZ

Introduction: A variety of rare malignant, benign and metastatic tumors of the pancreas have been identified (Table 1). The metastatic disease to the pancreas is rare and comprises 2%-4% of the pancreatic mass. In cases with known primary metastatic disease, the pancreatic metastatic disease prevalence still ranges from 3%-12%. The pancreatic-specific imaging modalities provide further non-invasive characterization of the tumor (Table 1). We present a rare nonobstructive metastatic tumor of the pancreatic head in a patient with a recent diagnosis of the clear cell sarcoma (CCS) of the hand.

Case Description/Methods: A 36-year-old man with prior history of chronic hepatitis C was sent from the correctional facility with complaints of left-hand mass and worsening pain. The symptoms started with the left-hand nodule which had progressively increased in size and diagnosed to have clear cell sarcoma of the hand. The patient had declined curative approach with left-hand amputation. On presentation, the physical examination was remarkable for left hand fungating mass with tenderness, restricted range of motion, and left axillary adenopathy. He had normocytic anemia, elevated serum lipase, and normal LFTs. The staging workup revealed left axillary adenopathy and pancreatic head mass measuring 6.5 cm associated with superior mesenteric vein encasement (Figure-1a). The axillary lymph node biopsy was inconclusive. The CA 19-9 was mildly elevated. Subsequently, EUS guided pancreatic head mass FNB (Figure-1b/1c) showed a small blue cell tumor, consistent with the patient's history of clear cell sarcoma. Given the aggressive metastatic disease and the chemo-resistant nature of the tumor the patient declined palliative chemotherapy and opted for comfort measures.

Discussion: CCS is a rare and aggressive soft tissue tumor and often misidentified as melanoma due to similar clinical, pathologic, and molecular properties. It rarely metastasized to the GI tract and the pancreas is among the most infrequent site. Imaging and clinical features of pancreatic sarcoma are nonspecific depending on location and local involvement. The metastatic sarcoma to the pancreas may present a diagnostic and therapeutic challenge due to its rarity and the difficulty in distinguishing between primary and metastatic tumors based on their radiologic features. The index of suspicion for metastatic sarcoma in the pancreas is still extremely low, and a standard management regimen for metastatic pancreatic sarcoma has not been established.




Disclosures:


Anila Mahesh, MBBS¹, Deepak Kumar, MBBS², Manisha Devi, MBBS¹, Kishore Kumar, MD³. P0072 - The Case Report of Sarcoma Metastasis to the Pancreas, a Rare Metastatic Tumor of the Pancreas, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.