Pancreatic cystic neoplasms (PCNs) are a frequent incidental fnding during an ultrasound or other radiological investigations. As PCNs may have a potential of malignancy, a precise diferential diagnosis between a malignant and benign lesion is crucial to defne appropriate management of patients with this kind of lesions. Radiology, with computed tomography (CT) and magnetic resonance imaging, may not be conclusive in the diagnostic assessment of PCNs. Endoscopic ultrasound (EUS), a simple and relatively low invasive technique, is able to identify intra-cystic worrisome features suggesting malignancy.
Ultrasound or other radiological
Fine-needle aspiration (FNA); of the cystic fuid or of intra-cystic tissue nodule during EUS is an adjunctive procedure for reaching a conclusive diagnosis. As EUS-FNA is burden by complications; the use of intravenous contrast may increase the diagnostic accuracy of EUS allowing in many cases a correct diagnosis of PCN at high risk of malignancy; without additional risk of complication during the procedure.
The present report deals with the case of a cystic lesion found by CT scan in the pancreatic head of a 59-year-old woman sufering from mild epigastric pain. Once submitted to EUS; malignant nature of PCN was suspect due to the fnding of a typical worrisome feature; the presence of a mural nodule. The intravenous administration of contrast medium during the EUS confrm malignancy and the patient was immediately sent to the surgeon for pancreatic resection.
CT scan in the pancreatic
Histology revealed an intraductal papillary mucinous neoplasm; with areas of high-grade dysplasia in the main and secondary ducts, progressed toward an invasive carcinoma potential of malignancy. While serous cystadenoma has no risk of malignancy and generally does not require surgery; the other two types of PCNs have a high risk to progress toward malignancy and warrant surgery. Therefore; an accurate characterization of a PCN is mandatory for discriminating which patients are in need of a rapid surgery in respect to those who can be followed up.
The present report deals with the case of a middle-aged woman with a cystic lesion in the pancreatic head incidentally found by a CT scan and fnally revealed to be an invasive carcinoma originating from an intraductal papillary mucinous neoplasm (IPMN); with areas of high-grade dysplasia in the main and secondary ducts.
Invasive carcinoma originating
A 59-year-old woman referred to our gastroenterology unit following the fnding of a PCN by a CT scan performed for the presence of abdominal pain and weight loss. At a clinical visit, the patient was not jaundiced; when interviewed she described the abdominal pain as mild; in the epigastric area, persisting from 3 months in absence of nausea, or digestive changes. No history of acute pancreatitis or other relevant diseases was present.