• A 79 years old Female
  • Presented with pain in the abdomen radiating to back
  • No H/O Fever, vomiting, Jaundice or Weight Loss
  • USG Abdomen – Normal
  • CT Abdomen – Hypodense area in the body of pancreas, 9 mm peripancreatic node superior to the lesion, Fat stranding around the pancreas S/O Focal  Pancreatitis
  • EUS revealed an irregular hypoechoic lesion at the junction of genu and body of pancreas (3 cm X 1.8 cm) which was adherent to splenic artery with few hypoechoic sub centimeter lymph nodes in the peritumorous region. Lesion was obstructing the main pancreatic duct leading to dilated MPD in body and tail of pancreas.
  • EUS FNA with 22 G needle under color Doppler control was performed
  • Cytological examination report suggested it to be adenocarcinoma of pancreas

Expert Comments:

  • The accuracy of conventional US for diagnosing pancreatic tumors is only 50-70%1
  • Sensitivity for detection of  pancreatic cancer of less than 2 cm size with CT scan and EUS is 40 % and 100% respectively2
  • Sensitivity for detection of pancreatic cancers of size 2-3 cm with CT scan and EUS is 84% and 100% respectively2
  • EUS is highly sensitive in detecting invasion of major vascular structure along with small lymphnode metastasis

Take Home Message:

  • More than 50% of the pancreatic cancers are diagnosed at stage IV of the disease
  • Reason being the low sensitivity and specificity of CT, MRI and PET scan in detecting small tumors, vascular invasion and subcentimeter sized lymphnodes
  • Elderly patient’s should be suspected of pancreatic neoplasm in the event of recent onset diabetes, first episode of pancreatitis, weight loss and jaundice as in this case this old female ( 79 years) presented with features of pancreatitis without any other disease defining signs or symptoms

References:

  1. Fumihiko Miura, Tadahiro Takada, Hodaka Amano, Masahiro Yoshida, Shigeru Furui, Koji Takeshita. Diagnosis of pancreatic cancer. HPB, 2006; 8: 337-342
  2. Agarwal B, Abu-Hamda E, Molke KL, Correa AM, Endoscopic ultrasound-guided fine needle aspiration and multidetector spiral CT in the diagnosis of pancreatic cancer. Am J Gastroenterol. 2004 May;99(5):844-50
3 cm X 1.8 cm Pancreatic mass

3 cm X 1.8 cm Pancreatic mass

0.9 cm peripancreatic lymphnode

0.9 cm peripancreatic lymphnode

 

 

 

 

 

 

 

 

 

Pancreatic mass in close proximity of splenic artery

Pancreatic mass in close proximity of splenic artery

EUS guided FNA from the pancreatic mass

EUS guided FNA from the pancreatic mass

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