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A CT image: A hypodense mass of 30 mm in diameter in the pancreatic tail in the arterial phase (arrows) (a), with increasing enhancement in the equilibrium phase (arrows) (b).
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CEA level (Table 1). Computed tomography (CT) showed a hypodense mass in the pancreatic tail of 30 mm in the largest diameter, with delayed enhancement (Fig. 1).
An EUS image: A hypoechoic mass in the pancreatic tail with an irregular lesion border.
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EUS showed a hypoechoic mass in the pancreatic tail with an irregular lesion border (Fig. 2).
Histopathological sections: In the EUS-FNA specimen, Hematoxylin and Eosin (H&E) staining showing adenocarcinoma with tall columnar epithelial cells, sparse nuclear stratification and necrosis (a), CK7- (b), CK20+(c), and CDX2+(d). These findings were similar to the H&E staining findings (e), CK7- (f), CK20+(g), and CDX2+(h) in the resected primary rectal cancer specimen.
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A histopathological examination of the resected pancreatic specimen, which included immunohistochemical staining, showed the same findings as the EUS-FNA findings (Fig. 3).
Histopathological sections from the metastatic pulmonary tumor: Hematoxylin and Eosin staining showing adenocarcinoma (a), CK7- (b), CK20+(c), and CDX2+(d). These findings were the same as those in the primary rectal cancer.
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The histopathological and immunohistochemical staining findings were consistent with the patient's rectal cancer (Fig. 4).