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Papillary thyroid carcinoma (PTC) is generally associated with excellent longterm outcome and survival [1, 2]. PTC recurrence is most common in regional cervical lymph nodes and only 5%–7% of patients show a distant disease, most commonly in lung, bone, and brain [3]. Pancreatic PTC metastasis represents an extremely rare event and endoscopic ultrasound (EUS) plays a fundamental role in diagnosis, histological characterization, and therapeutic decision making [4, 5]. A 60-year-old man presented with a pancreatic solid mass (evidenced by computed tomography and magnetic resonance imaging) after recurrent pancreatitis. He had undergone thyroidectomy 15 years earlier for PTC and two subsequent extended lymphadenectomies for lymph node metastases. Subsequently, he presented paratracheal, pulmonary, and brain metastases. EUS was performed using a linear echoendoscope (EG3870UTK; Pentax Medical, Tokyo, Japan) with the patient in the left lateral position and under deep sedation. A solid hypoechoic and hypervascular 20-mm lesion (▶Fig. 1) was apparent in the pancreatic head, with peculiar intraductal growth in the dorsal duct and main pancreatic duct (MPD), and initial dilation upstream (▶Video 1). Fine-needle aspiration (25 G Expect SlimLine; Boston Scientific, Marlborough, Massachusetts, USA) and biopsy (25 G Acquire; Boston Scientific) were performed with rapid on-site evaluation by an expert cytopathologist. The final pathological diagnosis was PTC pancreatic metastasis. At 2 months after the first EUS, the patient was evaluated for possible radiofrequency ablation (RFA) of the lesion under EUS guidance; however, pancreatic metastasis had increased in size and E-Videos

Pancreatic metastasis of papillary thyroid carcinoma with an intraductal growth pattern