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Cystic neuroendocrine tumor in the pancreas detected by endoscopic ultrasound and fine-needle aspiration: a case report.

Thorlacius H, Kalaitzakis E, Johansson GW, Ljungberg O, Ekberg O, Toth E - BMC Res Notes (2014)

Bottom Line: Laboratory tests were normal.The main pancreatic duct was normal without any connection to the cystic process.Differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology, such as computed tomography and magnetic resonance imaging.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, 20502, Sweden. henrik.thorlacius@med.lu.se.

ABSTRACT

Background: Pancreatic neuroendocrine tumors are typically solid neoplasms but in very rare cases present as cystic lesions. The diagnosis of cystic tumors in the pancreas is extremely difficult and the use of endoscopic ultrasound and fine-needle aspiration might be helpful in the work-up of patients with cystic neuroendocrine tumors in the pancreas.

Case presentation: A 78-year-old Caucasian man was admitted with a history of epigastric pain. Laboratory tests were normal. The patient underwent transabdominal ultrasound, computed tomography and magnetic resonance cholangiopancreatography demonstrating an unclear cystic mass in the head of the pancreas. The patient was referred for endoscopic ultrasound. Endoscopic ultrasound showed a hypoechoic lesion (42 × 47 mm) in the head of the pancreas with regular borders and large cystic components. The main pancreatic duct was normal without any connection to the cystic process. The lesion underwent fine-needle aspiration (22 Gauge). Cytological examination demonstrated cohesive groups of plasmacytoid cells staining positively for synaptophysin and chromogranin A, which is suggestive of a neuroendocrine tumor.

Conclusions: Differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology, such as computed tomography and magnetic resonance imaging. This unusual case with a pancreatic cystic neuroendocrine tumor highlights the clinical importance of endoscopic ultrasound in the work-up of patients with unclear lesions in the pancreas.

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Endoscopic ultrasound image revealing a cystic lesion with regular well-demarked borders in the head of pancreas.
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Figure 2: Endoscopic ultrasound image revealing a cystic lesion with regular well-demarked borders in the head of pancreas.

Mentions: A 78-year-old Caucasian man presented with epigastric pain. He was otherwise healthy except mild hypertension and asthma and laboratory tests were normal. Transabdominal ultrasound revealed a suspicious lesion in the head of the pancreas measuring 4 cm. A subsequent abdominal contrast-enhanced computed tomography depicted an unclear lesion as a mass (4 × 5 cm) with heterogeneous attenuation containing both solid and cystic components without signs of bile duct or pancreatic duct dilatation although engagement of the superior mesenteric vein was suspected (Figure 1). A magnetic resonance cholangiopancreatography did not add further diagnostic information and the patient was referred for endoscopic ultrasound. Endoscopic ultrasound demonstrated a hypoechoic lesion measuring 42 × 47 mm in the head of the pancreas with regular borders and large cystic components (Figure 2). The diameter of the pancreatic duct was normal and there was no morphological connection between the process and the pancreatic duct. Both the cystic and the solid components of the process underwent fine-needle aspiration (22 Gauge) (Figure 3). The fluid from the cystic component had low viscosity and contained normal levels of carcinoembryonic antigen (<1 μg/l) and amylase (2.5 μKat/l). Cytological examination of the aspirate from the solid component showed cohesive groups of plasmacytoid cells (Figure 4), staining positively for synaptophysin and chromogranin A (Figure 5), which are highly specific markers for neuroendocrine tumors [5]. Ki-67 index was less 2% making this a G1-type tumor but the engagement of the superior mesenteric vein made surgery non-optional and the patient received palliative chemotherapy.


Cystic neuroendocrine tumor in the pancreas detected by endoscopic ultrasound and fine-needle aspiration: a case report.

Thorlacius H, Kalaitzakis E, Johansson GW, Ljungberg O, Ekberg O, Toth E - BMC Res Notes (2014)

Endoscopic ultrasound image revealing a cystic lesion with regular well-demarked borders in the head of pancreas.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4127522&req=5

Figure 2: Endoscopic ultrasound image revealing a cystic lesion with regular well-demarked borders in the head of pancreas.
Mentions: A 78-year-old Caucasian man presented with epigastric pain. He was otherwise healthy except mild hypertension and asthma and laboratory tests were normal. Transabdominal ultrasound revealed a suspicious lesion in the head of the pancreas measuring 4 cm. A subsequent abdominal contrast-enhanced computed tomography depicted an unclear lesion as a mass (4 × 5 cm) with heterogeneous attenuation containing both solid and cystic components without signs of bile duct or pancreatic duct dilatation although engagement of the superior mesenteric vein was suspected (Figure 1). A magnetic resonance cholangiopancreatography did not add further diagnostic information and the patient was referred for endoscopic ultrasound. Endoscopic ultrasound demonstrated a hypoechoic lesion measuring 42 × 47 mm in the head of the pancreas with regular borders and large cystic components (Figure 2). The diameter of the pancreatic duct was normal and there was no morphological connection between the process and the pancreatic duct. Both the cystic and the solid components of the process underwent fine-needle aspiration (22 Gauge) (Figure 3). The fluid from the cystic component had low viscosity and contained normal levels of carcinoembryonic antigen (<1 μg/l) and amylase (2.5 μKat/l). Cytological examination of the aspirate from the solid component showed cohesive groups of plasmacytoid cells (Figure 4), staining positively for synaptophysin and chromogranin A (Figure 5), which are highly specific markers for neuroendocrine tumors [5]. Ki-67 index was less 2% making this a G1-type tumor but the engagement of the superior mesenteric vein made surgery non-optional and the patient received palliative chemotherapy.

Bottom Line: Laboratory tests were normal.The main pancreatic duct was normal without any connection to the cystic process.Differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology, such as computed tomography and magnetic resonance imaging.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, 20502, Sweden. henrik.thorlacius@med.lu.se.

ABSTRACT

Background: Pancreatic neuroendocrine tumors are typically solid neoplasms but in very rare cases present as cystic lesions. The diagnosis of cystic tumors in the pancreas is extremely difficult and the use of endoscopic ultrasound and fine-needle aspiration might be helpful in the work-up of patients with cystic neuroendocrine tumors in the pancreas.

Case presentation: A 78-year-old Caucasian man was admitted with a history of epigastric pain. Laboratory tests were normal. The patient underwent transabdominal ultrasound, computed tomography and magnetic resonance cholangiopancreatography demonstrating an unclear cystic mass in the head of the pancreas. The patient was referred for endoscopic ultrasound. Endoscopic ultrasound showed a hypoechoic lesion (42 × 47 mm) in the head of the pancreas with regular borders and large cystic components. The main pancreatic duct was normal without any connection to the cystic process. The lesion underwent fine-needle aspiration (22 Gauge). Cytological examination demonstrated cohesive groups of plasmacytoid cells staining positively for synaptophysin and chromogranin A, which is suggestive of a neuroendocrine tumor.

Conclusions: Differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology, such as computed tomography and magnetic resonance imaging. This unusual case with a pancreatic cystic neuroendocrine tumor highlights the clinical importance of endoscopic ultrasound in the work-up of patients with unclear lesions in the pancreas.

Show MeSH
Related in: MedlinePlus