Pancreatic neuroendocrine tumor trapped in a cyst

Pancreatic neuroendocrine tumor (Pan NET) accounts for only 1–2% of pancreatic neoplasms and <1% of tumors present as cystic lesions. A diagnosis of cystic tumor in the pancreas can be very challenging and confusing. Endoscopic ultrasound (USG) and fine needle aspiration (FNA) of these cystic lesions can help the clinician to narrow down the differential diagnosis. A multidisciplinary approach is warranted for a definitive diagnosis and optimal treatment. Here, we present to you a very rare case of Pan NET presenting as a cystic mass. A 65-year-old man was admitted with a history of abdominal pain. Laboratory tests showed increased levels of serum amylase, and other biochemical tests were normal. The patient underwent transabdominal USG and computed tomography (CT). CT showed well-defined cystic lesion in the proximal body of the pancreas. Endoscopic guided FNA (EUS-FNA) using 22 gauges was done. Cytological examination demonstrated clusters and sheets of plasmacytoid cells. EUS core needle biopsy was done which showed loose clusters of cells with fine uniformly distributed chromatin that stained positively for insulinoma associated protein-1 which was suggestive of a Pan NET. The differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology such as CT and magnetic resonance imaging. Cytology is helpful for a pre-operative diagnosis of cystic Pan NET. A diagnosis of Pan NET in a pancreatic biopsy or FNA with limited and suboptimal material is often challenging. This unusual case highlights the importance of pre-operative workup of EUS followed by FNAC in cystic pancreatic lesions.

A COMPARATIVE STUDY OF PANCREATIC PSEUDOCYST TREATED WITH ULTRASOUND GUIDED ASPIRATION VERSUS CONVENTIONAL SURGERY

Background: Pancreatic pseudocysts belong to a large and hetero-geneous group of cystic pancreatic lesions and represent a complication of acute or chronic pancreatitis. This is a prospect Material and Methods: ive study conducted in the department of General surgery, at darbhanga medical college and Hospital, Darbhanga, Laheriasarai, Bihar. Study duration on One year. Conclusion: Ultrasound guided aspiration is equally safe compared to conventional surgery, It not only cures but provides palliation of symptoms and gives enough time needed for maturation of the cyst.

Cystic pancreatic lesions: MR imaging findings and management

Cystic pancreatic lesions (CPLs) are frequently casual findings in radiological examinations performed for other reasons in patients with unrelated symptoms. As they require different management according to their histological nature, differential diagnosis is essential. Radiologist plays a key role in the diagnosis and management of these lesions as imaging is able to correctly characterize most of them and thus address to a correct management. The first step for a correct characterization is to look for a communication between the CPLs and the main pancreatic duct, and then, it is essential to evaluate the morphology of the lesions. Age, sex and a history of previous pancreatic pathologies are important information to be used in the differential diagnosis. As some CPLs with different pathologic backgrounds can show the same morphological findings, differential diagnosis can be difficult, and thus, the final diagnosis can require other techniques, such as endoscopic ultrasound, endoscopic ultrasound-fine needle aspiration and endoscopic ultrasound-through the needle biopsy, and multidisciplinary management is important for a correct management.

Role of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Cystic Pancreatic Lesions

Background: The diagnosis and management of cystic lesions of the pancreas is an increasingly recognized problem in clinical practice and many of the cystic pancreatic lesions are neoplastic and asymptomatic. Despite the significant advances occurred over the last decades, it remains difficulty to accurately distinguish between benign (serous cystic lesions) and malignant or potentially malignant (mucinous cystic lesions) pancreatic cysts before resecting them. Mucinous cystic neoplasms (MCNs), intrapapillary mucinous neoplasms (IPMN) and serous cystic neoplasms (SCNs) can display differences when examined by imaging modalities, endoscopic ultrasonography (EUS) and cytological and biochemical analyses of cyst fluid. The performance characteristics of high-resolution computed tomography (CT) scanning and magnetic resonance imaging (MRI) in making these distinctions are, however, disappointing. The aim of this study is to evaluate the role of endoscopic ultrasound guided fine needle aspiration (FNA) in diagnosis of cystic pancreatic lesions and its accuracy in discrimination between benign, malignant and potentially malignant cysts. Methods: The study was organized as a prospective study and conducted over 51 patients with identified cystic pancreatic lesions from prior radiological imaging (CT or MRI). Results: EUS guided FNA has shown superior sensitivity, specificity, positive predictive value and negative predictive value in comparison to EUS alone in discriminating mucinous from non-mucinous cysts. This difference was remarkable specially for malignant cysts (mucinous cystadenocarcinoma, adenocarcinoma) and cystic lymphangioma. EUS-FNA associated with chemical and physical analysis of cyst fluid was 100% sensitive and specific. Cyst fluid CEA revealed significant importance in differentiating mucinous from non mucinous cysts. Cyst fluid amylase was significantly high in pseudocysts while mucin stain was important to discriminate mucinous from non-mucinous cystic lesions. Conclusion: EUS-FNA has proven greater sensitivity and specificity, positive predictive, negative predictive value in differentiating mucinous and non-mucinous pancreatic cystic lesions as well as pathological categorization into subtypes.

Focal Pancreatic Lesions: Role of Contrast-Enhanced Ultrasonography

The introduction of contrast-enhanced ultrasonography (CEUS) has led to a significant improvement in the diagnostic accuracy of ultrasound in the characterization of a pancreatic mass. CEUS, by using a blood pool contrast agent, can provide dynamic information concerning macro- and micro-circulation of focal lesions and of normal parenchyma, without the use of ionizing radiation. On the basis of personal experience and literature data, the purpose of this article is to describe and discuss CEUS imaging findings of the main solid and cystic pancreatic lesions with varying prevalence.

Lymphoepithelial Cyst of the Pancreas: Can Common Imaging Features Help to Avoid Resesction?

Background: Differentiation of cystic pancreatic neoplasms remains a challenging task for radiologists with main aim of characterizing malignant and premalignant conditions. Purpose: The study aimed to compare radiological features of lymphoepithelial cysts (LEC) with other cystic pancreatic lesions, which could help to differentiate them in order to avoid unnecessary resection and optimize surveillance.Material and Methods: We retrospectively reviewed 12 cases of resected and histopathological confirmed LECs in last 12 years, for 10 patients imaging studies were available. 20 patients with mucinous cystic neoplasms (MCN) and 20 patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) were selected consecutively to serve as control groups. Imaging findings as well as clinical data were analyzed. Results: Three imaging subtypes of LEC were identified: simple cystic morphology (20%) and mixed cystic-solid lesions (80%) with either diffuse subsolid component (30%) or mural nodule (50%). All lesions revealed exophytic location with strong male predominance (9:1). MCNs were presented exclusively in middle-aged woman and IPMN in both sexes showing slight male predominance (13:7). Mean patient age in IPMN (70.5+7.7 years) was significantly higher compared to other groups (p<0.001 for LEC, p=0.005 for MCN). Unenhanced CT-attenuation of LEC was higher than MCNs (p=0.025) and IPMNs (p=0.021). Conclusion: The present study provides three imaging subtypes of LEC with key features for the differentiation from other cystic pancreatic lesions such as increased native attenuation, absence of connection to main pancreatic duct (MPD) and exophytic location. Clinical data, such as male predominance in LEC, is crucial in differentiating cystic pancreatic lesions.