We present a 73-year-old male, non-insulin dependent diabetic, with personal history of renal lithiasis and prostate adenocarcinoma Gleason 7 treated with radiotherapy and insulin therapy.
She came to the Emergency Department because of a cutaneous-mucosal irritation, choluria and nocturia.
It also presents a general syndrome with loss of 20 kg of weight and hyperglycemias maintained in the last two months.
On admission, the presence of elevated bilirubin (6.8 g/dl) and hypertransaminasemia (AST 101 U/l, ALT U/l) alkaline stasis (GGT 336 U/l) were confirmed.
The rest of the parameters except blood glucose are within normal limits.
On admission, an abdominal ultrasound was performed, showing a large heterogeneous pancreatic mass of 6.2 x 5.8 x 6.4 cm, compatible with a neoplasic process, identifying the presence of focal retroperitoneal and hepatic aspletic lymph node involvement with minimal.
Also described is a dilatation of the intrahepatic and extrahepatic bile duct with distended gallbladder with abundant biliary mud and microcalcifications inside.
With the suspicion of pancreatic cancer, EUS was performed using the linear coherence (PENTAX EG-3870UTK), which confirms the presence of a large lesion in the head of the pancreas, with a predominantly irregular pancreatic duct.
A large number of adenopathies are identified in the celiac trunk, peripancreatic and hepatic hilium.
Endoscopic imaging shows the presence of a large deformity of the posterior aspect of the duodenal knee, where a tumoral ulcerative lesion measuring about 3 cm in size is located, with spontaneous bleeding and adhered clots, probably related.
EUS-guided needle biopsy of the pancreatic lesion was performed.
Anatomopathological study of the sample revealed the presence of an undifferentiated malignant tumor compatible with fusocellular sarcoma, with negative immunohistochemistry for cytokeratins, c-KIT and CD34 tumor suggestive of sarcomatous origin.
The patient had a poor prognosis and rapid tumor progression that ended with the death of the patient.
