However, there was uptake of 18-fluorodeoxyglucose (FDG) with a standard uptake value (SUV) of 4.3-4.7 in the medial left supraclavicular region that was suspicious for nodal metastasis ( Figures 2 and 3). CT scan of the neck did not demonstrate any evidence of supraclavicular metastasis ( Figure 1). Therefore, PET/CT scan was performed where no liver metastases were noted. The initial CT scan of the abdomen showed nodules in the liver that were suspicious but not confirmatory for metastasis. The patient had unresectable disease given that the tumor encased approximately 180 degrees of the superior mesenteric artery. Fine needle aspiration cytology (FNAC) of the pancreatic mass confirmed welldifferentiated ductal adenocarcinoma. He was found to have a pancreatic head mass on a transabdominal ultrasound and CT scan of the abdomen. In this report, we present three additional cases of pancreatic adenocarcinoma with supraclavicular lymph node metastasis leading to an alteration of staging and subsequent treatment plans.Ī 51-year-old Caucasian male presented with a history of progressive jaundice, loss of weight, acholic stools, and bilirubinuria. One study done to assess role of PET/CT in detection of occult metastasis in pancreatic adenocarcinoma showed a 2.4% prevalence (2 out of 82 cases) of supraclavicular metastasis in pancreatic adenocarcinoma. The incidence and prevalence of metastatic pancreatic cancer to distant lymph nodes in the head/neck/cervical region has not been well defined. Five of these cases were identified from three studies done to assess efficacy of positron emission tomography/computed tomography (PET/CT) or PET scans in detection of distant metastasis in pancreatic adenocarcinoma. A review of the literature reveals only six cases of supraclavicular metastasis from pancreatic adenocarcinoma. Supraclavicular metastasis from pancreatic cancer has thus far been considered an infrequent occurrence. Unusual sites of metastases such as muscle, skin, heart, pleura, stomach, umbilicus, kidney, appendix, spermatic cord and prostate have also been reported in pancreatic cancer. The lungs, bones and the brain are less commonly involved. The liver and peritoneal cavities are common sites of metastases in pancreatic cancer. Pancreatic cancer represents an unusual primary for supraclavicular lymph node metastases. Supraclavicular lymph node metastases are a common occurrence in breast cancer, lung cancer, gastroesophageal cancer and lymphoma. RECIST: Response Evaluation Criteria In Solid Tumors INTRODUCTION Lymphatic Metastasis Pancreatic Neoplasms Positron-Emission Tomography Tomography, Emission- Computed Tomography, X-Ray Computed Abbreviations PET imaging represents a valuable tool in the detection and follow up of these patients. Conclusion In patients with pancreatic adenocarcinoma, supraclavicular lymph node metastasis represents an uncommon, but clinically significant finding that can lead to changes in treatment planning. PET/CT results were consistent with these findings. Excisional biopsy of a supraclavicular lymph node showed metastatic pancreatic adenocarcinoma. Histopathology revealed grade 3 pancreatic adenocarcinoma. Staging evaluations revealed a pancreatic mass for which he underwent subtotal pancreatectomy and splenectomy. Fine needle aspiration cytology was consistent with known papillary thyroid carcinoma. The third patient, a 79-year-old male with a past history of thyroid carcinoma who was treated with partial thyroidectomy, developed neck swelling 4 years after his surgery. PET/CT scan and biopsy revealed supraclavicular lymph node metastasis from a pancreatic adenocarcinoma primary. However, the patient complained of neck swelling. She received adjuvant chemotherapy and was followed-up with surveillance CT scans, which did not reveal any metastasis. The second patient, a 66-year-old female with pancreatic adenocarcinoma, underwent pancreaticoduodenectomy and was found to have peripancreatic lymph node involvement. The patient received systemic chemotherapy for metastatic pancreatic adenocarcinoma. However, positron emission tomography (PET)/CT scans and subsequent fine needle aspiration cytology showed supraclavicular lymph node metastasis. He was recommended neoadjuvant chemotherapy followed by chemoradiation therapy. Case report A 51-year-old male was diagnosed with locally advanced pancreatic adenocarcinoma on computed tomography (CT) scan. We report three cases of pancreatic adenocarcinoma with metastases to supraclavicular lymph nodes. Context Supraclavicular lymph nodes represent a rare site of metastasis in pancreatic cancer.