Endoscopic Ultrasound Fine-Needle Aspiration Detection of Extravascular Migratory Metastasis From a Remotely Located Pancreatic Cancer

Background & Aims: Tumor cell migration along the periphery of blood vessels to remote sites has been termed extravascular migratory metastasis, which is distinct from direct gross tumor infiltration of blood vessels and from intravascular dissemination. Our objective was to report the presence of malignant perivascular cuffing of the celiac axis in a patient with an apparently early T stage and resectable pancreatic cancer. Methods: Case report is presented. Results: Endoscopic ultrasound (EUS) examination was performed with targeted fine-needle aspiration (FNA) of previously unrecognized perivascular cuffing by computed tomography, which established the presence of celiac axis malignant perivascular cuffing in the setting of a T1 pancreatic cancer. Conclusions: EUS FNA might allow identification and tissue confirmation of otherwise unrecognized extravascular migratory metastasis. This finding suggests the potential for EUS FNA to further improve pancreatic cancer staging and to enhance patient care and outcomes.