Clin Endosc > Volume 56(6); 2023 > Article
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Choi: A 66-year-old woman with a hypervascular pancreatic mass

Quiz

A 66-year-old woman with no previous medical history experienced early satiety and nonspecific epigastric pain for six months before visiting a local hospital. Computed tomography revealed a 2-cm solid mass with contrast enhancement in the pancreatic body (Fig. 1A). The patient was transferred to the pancreatic center of our institution for further evaluation. On presentation, the physical examination was unremarkable. Laboratory tests, which included pancreatic enzymes and tumor markers, were within the normal ranges.
Subsequent magnetic resonance imaging revealed a hypervascular mass in the pancreatic body (Fig. 1B). Endoscopic ultrasound (EUS) examination revealed a homogeneous, hypoechoic 2.0×1.8 cm mass (Fig. 2A), which exhibited strong enhancement on contrast-enhanced EUS (Fig. 2B, 12 seconds after injecting SonoVue, Bracco Inc.). EUS-guided fine-needle biopsy (FNB) was performed using a 22-gauge histology needle. However, the FNB specimens were insufficient for histopathological diagnosis.
What is the most likely diagnosis in this case?
 

NOTES

Conflicts of Interest
Jun-Ho Choi is currently serving as a KSGE Publication Committee member in Clinical Endoscopy; however, he was not involved in the peer reviewer selection, evaluation, or decision process of this article.
Funding
None.

Fig. 1.
Cross-sectional imaging of the pancreatic mass. (A) On computed tomography, the pancreatic mass showed increased contrast enhancement in the arterial phase (arrows). (B) The arterial phase on magnetic resonance imaging revealed the hypervascularity of the mass in the pancreatic body (arrows).
ce-2023-057f1.jpg
Fig. 2.
Endoscopic ultrasound. (A) B-mode endoscopic ultrasound revealed a well-defined, hypoechoic mass in the pancreatic body (arrowheads). (B) Contrast-enhanced harmonic imaging showing hyperenhancement inside the tumor.
ce-2023-057f2.jpg
Fig. 3.
Histopathological findings. (A) A photograph of a gross specimen of the mass revealed a round, well-defined, and solid mass measuring 20 mm in size. (B) Low magnification of the microphotograph revealed that the tumor was composed of numerous microcysts with densely fibrocollagenous stroma (hematoxylin and eosin stain, ×40). (C) Higher magnification of the microphotograph (hematoxylin-eosin stain, ×200) showing a single layer of bland-looking cuboidal epithelium resting on the fibrous cyst wall (hematoxylin and eosin stain, ×200).
ce-2023-057f3.jpg

REFERENCES

1. Wcislak SM, Stiles ZE, Deneve JL, et al. Hypervascular lesions of the pancreas: Think before you act. Am J Surg 2019;218:362–367.
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2. Kalb B, Sarmiento JM, Kooby DA, Adsay NV, Martin DR. MR imaging of cystic lesions of the pancreas. Radiographics 2009;29:1749–1765.
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3. Park HS, Kim SY, Hong SM, et al. Hypervascular solid-appearing serous cystic neoplasms of the pancreas: differential diagnosis with neuroendocrine tumours. Eur Radiol 2016;26:1348–1358.
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4. Nakamura S, Murata Y, Uchida K, et al. Microcystic serous cystadenoma mimicking pancreatic neuroendocrine neoplasm: report of a resected case with preoperative diagnostic difficulty and review of the literature. Surg Case Rep 2022;8:188.
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