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Case Report

Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report

  • Authors:
    • Takuya Ando
    • Yuki Hirose
    • Kazuyasu Takizawa
    • Jun Sakata
    • Hirosuke Ishikawa
    • Shun Abe
    • Yusuke Kawachi
    • Mae Nakano
    • Hiroshi Ichikawa
    • Yoshifumi Shimada
    • Toshifumi Wakai

  • View Affiliations / Copyright

    Affiliations: Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata 951‑8510, Japan
  • Article Number: 162
    |
    Published online on: March 5, 2026
       https://doi.org/10.3892/ol.2026.15515
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Abstract

Pancreatic head tumors are usually regarded as primary pancreatic neoplasms; however, metastatic lymph nodes from gastrointestinal malignancies may occasionally mimic pancreatic tumors and lead to diagnostic and therapeutic challenges, particularly when the primary lesion cannot be identified preoperatively. In the present case report, a 76‑year‑old man was referred for evaluation of a pancreatic head mass with elevated serum carbohydrate antigen 19‑9 levels. Contrast‑enhanced computed tomography and positron emission tomography‑computed tomography demonstrated a protruding lesion in the pancreatic head and an enlarged infrapyloric lymph node, without evidence of a primary gastrointestinal tumor. Esophagogastroduodenoscopy was unremarkable and primary pancreatic cancer was suspected. Endoscopic ultrasound‑guided biopsy of the infrapyloric lymph node revealed adenocarcinoma; however, the primary site could not be determined. Pancreaticoduodenectomy was planned. Intraoperatively, the lesion appeared to represent a bulky metastatic lymph node rather than a primary pancreatic tumor, and distal gastrectomy was additionally performed. Histopathological examination confirmed metastatic lymph node involvement from occult gastric cancer. The patient remains alive without evidence of recurrence 2 years after surgery. In conclusion, occult gastric cancer metastasis can masquerade as a pancreatic head tumor. Awareness of this diagnostic and surgical challenge may facilitate appropriate intraoperative reassessment when pancreatic head lesions are accompanied by suspicious perigastric lymphadenopathy.
View Figures

Figure 1

Radiologic imaging of a tumor in the pancreatic head. (A) Abdominal contrast-enhanced computed tomography shows 30-mm protruding mass in the pancreatic head with hypodensity (arrowheads), along with enhanced lymph nodes in the infrapyloric region (arrow). (B) Positron emission tomography-computed tomography reveals an abnormal uptake in both the pancreatic head lesion (arrowheads) and lymph nodes in the infrapyloric region (arrow).

Figure 2

Surgically resected specimen. The resected specimen shows a 30-mm protruding mass in the pancreatic head (arrowheads).

Figure 3

Hematoxylin and eosin staining. (A) A tumor in the pancreatic head was identified as a metastatic lymph node. (B) The metastatic lymph node contained signet ring cells and poorly differentiated adenocarcinoma with a large amount of mucinous component. (C) Microscopic vascular invasion was detected within the submucosa of the resected stomach. (D) Tumor cells within the submucosa of the resected stomach showed same histological features as metastatic lymph nodes. Scale bars indicate 1,000, 50, 500 and 50 µm, respectively.
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Copy and paste a formatted citation
Spandidos Publications style
Ando T, Hirose Y, Takizawa K, Sakata J, Ishikawa H, Abe S, Kawachi Y, Nakano M, Ichikawa H, Shimada Y, Shimada Y, et al: Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report. Oncol Lett 31: 162, 2026.
APA
Ando, T., Hirose, Y., Takizawa, K., Sakata, J., Ishikawa, H., Abe, S. ... Wakai, T. (2026). Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report. Oncology Letters, 31, 162. https://doi.org/10.3892/ol.2026.15515
MLA
Ando, T., Hirose, Y., Takizawa, K., Sakata, J., Ishikawa, H., Abe, S., Kawachi, Y., Nakano, M., Ichikawa, H., Shimada, Y., Wakai, T."Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report". Oncology Letters 31.5 (2026): 162.
Chicago
Ando, T., Hirose, Y., Takizawa, K., Sakata, J., Ishikawa, H., Abe, S., Kawachi, Y., Nakano, M., Ichikawa, H., Shimada, Y., Wakai, T."Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report". Oncology Letters 31, no. 5 (2026): 162. https://doi.org/10.3892/ol.2026.15515
Copy and paste a formatted citation
x
Spandidos Publications style
Ando T, Hirose Y, Takizawa K, Sakata J, Ishikawa H, Abe S, Kawachi Y, Nakano M, Ichikawa H, Shimada Y, Shimada Y, et al: Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report. Oncol Lett 31: 162, 2026.
APA
Ando, T., Hirose, Y., Takizawa, K., Sakata, J., Ishikawa, H., Abe, S. ... Wakai, T. (2026). Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report. Oncology Letters, 31, 162. https://doi.org/10.3892/ol.2026.15515
MLA
Ando, T., Hirose, Y., Takizawa, K., Sakata, J., Ishikawa, H., Abe, S., Kawachi, Y., Nakano, M., Ichikawa, H., Shimada, Y., Wakai, T."Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report". Oncology Letters 31.5 (2026): 162.
Chicago
Ando, T., Hirose, Y., Takizawa, K., Sakata, J., Ishikawa, H., Abe, S., Kawachi, Y., Nakano, M., Ichikawa, H., Shimada, Y., Wakai, T."Diagnostic and surgical challenges of a lymph node metastasis from occult gastric cancer mimicking a pancreatic head tumor: A case report". Oncology Letters 31, no. 5 (2026): 162. https://doi.org/10.3892/ol.2026.15515
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