EUS diagnosis of a primary pancreatic metastasis of alveolar rhabdomyosarcoma

Context: Alveolar rhabdomyosarcoma are rare malignancies. These lesions typically metastasize to the lungs, liver, and bone marrow. Pancreatic metastases from alveolar rhabdomyosarcoma are exceptionally uncommon. Case report: An 18-year-old man with a history of right orbital alveolar rhabdomyosarcoma, which had been treated with neoadjuvant therapy, surgery and adjuvant chemotherapy developed an episode of pancreatitis. CT at that time demonstrated acute pancreatitis with no mass lesions. Two months later, the patient developed abdominal pain and an MRI documented a 6.4 cm mass in the pancreatic body and tail. EUS guided FNA confirmed the diagnosis of alveolar rhabdomyosarcoma metastatic to the pancreas. Conclusion: To our knowledge this is the first reported case of EUS guided FNA diagnosis of alveolar rhabdomyosarcoma metastatic to the pancreas. This is also the only case report of a primary pancreatic metastasis of this type of tumor in a male patient (which occurs less commonly than in females).