• 74 years oild Female
  • Presenting with pain in the abdomen on and off and vomiting with pain radiating to back.
  • No History of weight loss or jaundice
  • CT Scan abdomen – 2.6×3.5×4.5 cm sized ill defined soft tissue lesion in retro peritoneum anterior to aorta and posterior to pancreas? Neoplasm? Lymphoma? Lymphnodes.Small cystic lesion involving distal body and tail of pancreas? Cystic neoplasm
  • PET CT – Poorly marginated  metabolically active soft tissue in retro pancreatic space
  • CA 19.9- 254.52 U/ml
  • EUS revealed an irregular hypoechoic solid-cystic exophytic lesion in the tail of the pancreas encasing the splenic vein. The mass extends posteriorly upto the aorta. In view of these findings EUS FNA was performed (two pass) from the suspicious lesion in the tail of pancreas and aspirated material was sent for cytological examination.
  • Cytological examination confirmed it to be low grade solid cystic neoplasm of pancreas

Expert Comments:

  • Most pancreatic neoplasms are classified as ductal adenocarcinomas because they show a ductal phenotype, making a ductal origin very likely.
  • Patients with three or more first-degree relatives with pancreatic cancer have a 14 to 32-fold increased risk of developing pancreatic cancer, and this risk is significant. 1
  • Endoscopic ultrasound (EUS) is one of the best available technologies to image the pancreas2 and  EUS has been  used to screen asymptomatic, apparently healthy, members of families in which there have already been several pancreatic cancers
  • Several studies have suggested increased sensitivity and specificity of endoscopic ultrasound (EUS) compared with other imaging modalities.
  • The greatest advantage of EUS is that it allows fine needle aspiration (FNA) of the tumor to provide a tissue diagnosis.

Take Home Message:

  • The identification and detection of pancreatic ductal adenocarcinoma at its beginning, preferably at preinvasive stage, improves patient survival.
  • The precursor lesions of pancreatic ductal adenocarcinomas include intraductal papillary mucinous neoplasms (IPMN) and Mucinous neoplasm, which are rare.
  • Pancreatic ductal neoplasias have been reported in 11% of patients of chronic pancreatitis, however patient’s age and duration of the disease does not correlate with the grade of such lesions.
  • Following were candidates for screening: First-degree relatives (FDRs) of patients with Pancreatic Cancers from a familial Panncreatic Cancer kindred with at least two affected FDRs; patients with Peutz-Jeghers syndrome; and p16, BRCA2 and hereditary non-polyposis colorectal cancer (HNPCC) mutation carriers with ≥ 1 affected FDR.
Solid-cystic mass in the tail of pancreas

Solid-cystic mass in the tail of pancreas

The mass encasing the aorta

The mass encasing the aorta

 

 

 

 

 

 

 

 

 

EUS guidd FNA from the suspicious mass lesion in the pancreas

EUS guidd FNA from the suspicious mass lesion in the pancreas

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