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IMAGES AND VIDEOS
Year : 2020  |  Volume : 9  |  Issue : 6  |  Page : 415-416

Histopathological and molecular study from EUS fine-needle biopsy of a programmed cell death ligand 1 positive, KRAS mutated pancreatic metastasis


1 Department of Hepatogastroenterology, University Hospital Center, Saint-Etienne, France
2 Division of Pathology and Clinical Laboratories, University Hospital Center, Saint-Etienne, France
3 Department of Pneumology, University Hospital Center, Saint-Etienne, France

Date of Submission28-Apr-2020
Date of Acceptance24-Aug-2020
Date of Web Publication14-Dec-2020

Correspondence Address:
Nicolas Williet
Department of Hepatogastroenterology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eus.eus_62_20

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How to cite this article:
Tournier Q, Casteillo F, Bayle-Bleuez S, Phelip JM, Williet N. Histopathological and molecular study from EUS fine-needle biopsy of a programmed cell death ligand 1 positive, KRAS mutated pancreatic metastasis. Endosc Ultrasound 2020;9:415-6

How to cite this URL:
Tournier Q, Casteillo F, Bayle-Bleuez S, Phelip JM, Williet N. Histopathological and molecular study from EUS fine-needle biopsy of a programmed cell death ligand 1 positive, KRAS mutated pancreatic metastasis. Endosc Ultrasound [serial online] 2020 [cited 2022 Jun 25];9:415-6. Available from: http://www.eusjournal.com/text.asp?2020/9/6/415/303356



On December 2019, a 73-year-old Caucasian man, smoker presented for concomitant pulmonary and pancreatic tumors showed by computerized tomography. A percutaneous biopsy of the pulmonary mass led to the diagnosis of a poorly differentiated non-small cell non squamous carcinoma with programmed cell death ligand 1 (PD-L1) overexpression (tumor proportion score = 100%), no staining for ALK and ROS1, and KRAS mutation (c.34G>T). By EUS, two adjacent tumors (20 mm and 13 mm) were showed in the pancreatic body and fine-needle biopsy (FNB) was performed using a 20 gauges ProCore needle [Figure 1]a. Quality of the tissue sampled was adequate for histopathological examination and immunohistochemical staining using antibodies (DAKO) including those for cytokeratin (CK7: Positive and CK20: Negative), thyroid transcription factor-1 (negative), ALK (negative), ROS1 (negative), and PD-L1: 100% of tumor cells [Figure 1]c,[Figure 1]d,[Figure 1]e,[Figure 1]f. Moreover, next-generation sequencing showed KRAS mutation (c.34G>T), exactly as the primary lung cancer [Figure 1]b. Following these results, it was concluded that pancreatic masses were metastases from the lung cancer and the patient started an anti-PD-L1 (Pembrolizumab®).
Figure 1: (a) EUS-fine needle biopsy of the two pancreatic masses. Samples issued from this EUS.fine needle biopsy allowed to conduct (b) next generation sequencing showing KRAS mutation (c.34G>T), (c) hematoxylin and eosin staining, (d) positive CK7 staining, (e) negative CK20 staining, (f) strongly positive (100%) for programmed cell death ligand 1 staining (scale bar in all panels = 200 μm)

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To conclude, our case report is a good example of the feasibility of a large panel of Histopathological and molecular analyses from EUS-FNB for pancreatic mass[1], in the era of molecularly targeted drugs (immunotherapy for MSI tumors, PARP inhibitors for BRCA mutated tumors, and NTRK-fusion inhibitors).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Oppong KW, Bekkali NLH, Leeds JS, Johnson SJ, Nayar MK, Darné A, et al. Fork-tip needle biopsy versus fine-needle aspiration in endoscopic ultrasound-guided sampling of solid pancreatic masses: a randomized crossover study. Endoscopy. 2020 Mar 11;  Back to cited text no. 1
    


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