Clin Endosc > Volume 53(5); 2020 > Article
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Han: Pancreatic Tail Mass: A Diagnostic Challenge


A 61-year-old female presented with an incidental finding of a pancreatic tail mass. She had been admitted for acute diarrhea and undergone abdominal computed tomography (CT) with contrast enhancement. CT showed a 2.6-cm, round, enhancing mass in the pancreatic tail (Fig. 1A). The patient had been diagnosed with essential hypertension two years ago, and she was taking antihypertensive medication. She was a non-smoker and remained abstinent for 10 years. There was no unintentional weight loss, fever, or abdominal pain. Abdominal examination showed no palpable mass. Complete blood count and liver function tests were all within the normal range. The cancer antigen 19-9 level was 9.1 U/mL (reference: <37 U/mL). Endoscopic ultrasonography (EUS) with radial echoendoscope showed a 1.9 cm × 2.3 cm, round, hypoechoic mass with well-defined margins at the pancreatic tail (Fig. 1B). There was no invasion of vascular structures or pancreatic duct dilatation. Contrast-enhanced EUS demonstrated homogenous enhancement of the mass (Fig. 1C). EUS-guided fine needle aspiration (EUS-FNA) of the mass was performed (Fig. 1D), but cytology did not reveal any malignant cells (Fig. 1E).

What is the most likely diagnosis?



Conflicts of Interest: The author has no financial conflicts of interest.

Fig. 1.
(A) Contrast-enhanced computed tomography demonstrates a 2.6-cm, round, enhancing mass in the pancreatic tail. (B) Endoscopic ultrasonography shows a 1.9 cm×2.3 cm round hypoechoic mass with well-defined margin at pancreatic tail. (C) Contrast-enhanced endoscopic ultrasonography shows homogenous enhancement of the mass. (D) Endoscopic ultrasound-guided fine needle aspiration is performed. (E) Cytology shows no malignant cells.
Fig. 2.
(A) Gross appearance of the resected specimen reveals a 2.3 cm×1.5 cm well-demarcated, dark brown mass in the pancreatic tail. (B) Microscopic examination reveals that the mass is surrounded by normal pancreatic tissue and composed of follicles and germinal centers (hematoxylin and eosin stain, ×20).


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