PR3-ANCA Granulomatosis With Polyangiitis Presenting as an FDG-Avid Pancreatic Body–Tail Mass Called Metastatic Adenocarcinoma on EUS-FNA — One Cycle of Gemcitabine Given Despite Normal CA 19-9 and CEA, Eosinophilia and Haemoptysis; Renal Biopsy Showing Crescentic GN Overturned the Diagnosis, 62-Year-Old Man, Sir Ganga Ram Hospital, New Delhi

Key finding

The cytology said cancer and the patient's own results said otherwise. For one cycle of chemotherapy, the cytology won. 1. The label and its cost. A PET-avid pancreatic mass with avid nodes is treated as pancreatic cancer until proven otherwise, and more than 85% of solid pancreatic lesions in adults are ductal adenocarcinoma. Here the working diagnosis was apparently confirmed by two tissue samples. The authors call the first FNA "a false-positive cytologic diagnosis in retrospect": GPA can mimic adenocarcinoma through desmoplastic stroma, ductal hyperplasia, inflammatory atypia and eosinophil-rich infiltrates. The label led to gemcitabine-based chemotherapy for a disease the patient did not have. That is documented harm, although limited to one cycle. 2. Normal results that were overridden. This is the reverse of the usual false-reassurance pattern. Here the norma

Framework connections: The Immune Priming, The Undersized Filter (Renal-Metabolic)

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