EUS-FNAによって扁平上皮癌と診断し得た原発不明後腹膜腫瘍の1例

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  • Retroperitoneal squamous cell carcinoma with unknown primary diagnosed by endoscopic ultrasound-guided fine needle aspiration

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An 80-year-old male presenting with abdominal distension was referred to our institution after being detected to have a positive test for fecal occult blood. Computed tomography revealed a retroperitoneal tumor. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) showed an invasive mass inside the inferior duodenal angle, and cytological examination confirmed the diagnosis of squamous cell carcinoma (SCC) . Despite careful examination, the origin of the tumor remained unclear. Analysis of specimens obtained during right hemicolectomy, partial hepatectomy, and mesenteric tumor resection confirmed the diagnosis of SCC.<br> Typically, retroperitoneal carcinoma is a metastatic cancer, and primary retroperitoneal carcinoma is extremely rare. This paper describes a case of retroperitoneal SCC diagnosed by EUS-FNA and considered as a case of carcinoma of unknown primary (CUP) . According to a widely accepted hypothesis about the onset of primary cancer in the retroperitoneum, these cancers arise from serous or mucinous metaplasia of pre-existing retroperitoneal coelomic mesothelium. In our case, the tumor specimens revealed no serous or mucinous metaplasia; therefore, the diagnosis of retroperitoneal SCC with CUP was considered more reasonable.<br> If a carcinomatous lesion does not contain an epithelial component, it is unlikely to be a primary tumor. In this case, EUS-FNA strongly suggested the diagnosis of SCC before surgery; therefore, the treatment course was changed. Thus, EUS-FNA was useful both for diagnosis and selection of the therapeutic strategy.

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