# A Case of Multiple Metastases in the Gastric Wall Due to Needle Tract Seeding after Endoscopic Ultrasound-Guided Tissue Acquisition for Pancreatic Tail Cancer

## TL;DR

A patient developed multiple gastric tumors from needle tract seeding after an endoscopic biopsy for pancreatic cancer, highlighting the risks and treatment options.

## Contribution

Reports a rare case of multiple synchronous needle tract seeding after EUS-TA for pancreatic cancer.

## Key findings

- Needle tract seeding led to multiple gastric wall recurrences three and a half years after surgery.
- Early detection of needle tract seeding allowed for surgical resection and improved patient prognosis.
- The patient remained recurrence-free after total gastrectomy and adjuvant chemotherapy.

## Abstract

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is widely used for the diagnosis of pancreatic cancer, other pancreatic tumors, and autoimmune pancreatitis. Among the adverse events, needle tract seeding (NTS) is the most concerning. NTS is a phenomenon in which tumor cells are observed at the site of biopsy needle passage. We herein report a case of multiple gastric wall recurrences resulting from NTS after laparoscopic distal pancreatectomy for pancreatic tail cancer.

A 71-year-old woman was diagnosed with pancreatic tail adenocarcinoma using EUS-TA and underwent laparoscopic distal pancreatectomy following neoadjuvant chemotherapy. Three and a half years postoperatively, two submucosal gastric lesions were identified and histologically confirmed as NTS. Since there was no recurrence at any site other than the site of NTS on close examination, a total gastrectomy was performed with postoperative adjuvant chemotherapy, and the patient remained recurrence-free.

We report a case of multiple synchronous NTS after EUS-TA. EUS-TA is a very useful examination method for pancreatic tumors; however, it should be performed with particular care in cases of invasive pancreatic ductal carcinoma after distal pancreatectomy. If NTS in the gastric wall is detected at an early stage, surgical resection is possible and the patient prognosis can be improved.