Skip Navigation
Skip to contents

Clin Endosc : Clinical Endoscopy

OPEN ACCESS

Articles

Page Path
HOME > Clin Endosc > Volume 57(5); 2024 > Article
Image of Issue Usefulness of micro forceps biopsy for cystic degenerated pancreatic neuroendocrine neoplasm
Takuya Doiorcid, Hirotoshi Ishiwatari,orcid, Junya Satoorcid, Hiroki Sakamotoorcid
Clinical Endoscopy 2024;57(5):688-689.
DOI: https://doi.org/10.5946/ce.2024.052
Published online: August 22, 2024

Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

Correspondence: Hirotoshi Ishiwatari Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan E-mail: ishihiro481019@gmail.com
• Received: March 3, 2024   • Revised: April 3, 2024   • Accepted: April 4, 2024

© 2024 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 951 Views
  • 64 Download
prev next
Endoscopic ultrasound (EUS) through-the-needle biopsy (EUS-TTNB) has been reported as a tissue sampling method for pancreatic cystic lesions (PCLs).1,2 The diagnostic yield of this method is higher than that of EUS-guided fine needle aspiration (EUS-FNA).3 Particularly, its utility has been reported for PCLs such as intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm. However, data on solid tumors with cystic degeneration are limited. Herein, we report a case in which EUS-TTNB was useful for the preoperative histological diagnosis of a pancreatic neuroendocrine neoplasm (PNEN) with a cystic component.
A 61-year-old man was referred to our hospital for further management of a cystic lesion in the pancreatic head. Contrast-enhanced computed tomography showed a 2-cm cystic lesion with enhancement effects on the cyst wall and a 4-mm hypervascular nodule (Fig. 1A, B). EUS revealed an anechoic cyst with a 4-mm nodule on the cyst wall, which showed early enhancement with Sonazoid contrast (GE Healthcare) (Fig. 1C). Considering its hypervascular nature, we suspected a cystic PNEN. However, the differential diagnoses included IPMN with mural nodules, pancreatic pseudocysts, and cystic degeneration of other solid tumors. Therefore, EUS-TTNB was performed to identify the lesion. The pancreatic cyst was punctured using a 19-gauge EUS-FNA needle (EZ Shot3; Olympus). Following the puncture, the stylet was withdrawn and 0.75-mm micro biopsy forceps (Moray Micro forceps; STERIS) were introduced through the FNA needle. Targeted biopsy of the solid nodule was performed thrice (Fig. 1D). The biopsy led to a diagnosis of PNEN (Fig. 2A, B), and pancreaticoduodenectomy was performed. The resected specimens showed densely proliferating small tumor cells in the cystic wall, confirming the diagnosis of PNEN (Fig. 2C, D). To the best of our knowledge, reports on EUS-TTNB for PNEN with cystic degeneration are few, and this case highlights its utility in preoperative diagnosis. We obtained approval of an informed consent waiver from the Institutional Ethics Committee of the Shizuoka Cancer Center (approval number: J2023-253-2023-1-3).
Fig. 1.
(A, B) Axial and coronal contrast-enhanced computed tomography scans reveal a 20-mm cystic lesion in the head of the pancreas during the arterial phase, with contrast enhancement observed in the cyst wall. A 4-mm nodule with strong contrast enhancement is also detected. (C) Contrast-enhanced endoscopic ultrasound using Sonazoid reveals contrast (GE Healthcare) enhancement in the cystic wall and nodule (arrow). (D) After puncturing with a 19-gauge fine needle aspiration needle, a biopsy is performed using 0.75-mm micro biopsy forceps (Moray Micro forceps; STERIS).
ce-2024-052f1.jpg
Fig. 2.
(A) Biopsy specimen shows that tumor cells with round nuclei proliferated in a trabecular or alveolar pattern (hematoxylin & eosin [H&E] stain, ×10). Immunohistochemical staining is positive for chromogranin A, leading to the diagnosis of pancreatic neuroendocrine neoplasm. (B) In the loupe image of the resected specimen, a cyst with a thin capsule is observed. (C) In the magnified image of the red-framed area of the image (B) where the biopsy specimen is taken, densely proliferating tumor cells are observed in the cyst wall (H&E stain, ×100). (D) In the loupe image of immunostaining with chromogranin A, positivity is observed in the cyst wall, leading to the diagnosis of cystic degeneration of pancreatic neuroendocrine neoplasm.
ce-2024-052f2.jpg
  • 1. Nakai Y, Isayama H, Chang KJ, et al. A pilot study of EUS-guided through-the-needle forceps biopsy (with video). Gastrointest Endosc 2016;84:158–162.ArticlePubMed
  • 2. Barresi L, Crinò SF, Fabbri C, et al. Endoscopic ultrasound-through-the-needle biopsy in pancreatic cystic lesions: a multicenter study. Dig Endosc 2018;30:760–770.ArticlePubMedPDF
  • 3. Yang D, Trindade AJ, Yachimski P, et al. Histologic analysis of endoscopic ultrasound-guided through the needle microforceps biopsies accurately identifies mucinous pancreas cysts. Clin Gastroenterol Hepatol 2019;17:1587–1596.ArticlePubMed

Figure & Data

REFERENCES

    Citations

    Citations to this article as recorded by  

      • PubReader PubReader
      • ePub LinkePub Link
      • Cite
        CITE
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Usefulness of micro forceps biopsy for cystic degenerated pancreatic neuroendocrine neoplasm
        Clin Endosc. 2024;57(5):688-689.   Published online August 22, 2024
        Close
      • XML DownloadXML Download
      Figure
      • 0
      • 1
      Usefulness of micro forceps biopsy for cystic degenerated pancreatic neuroendocrine neoplasm
      Image Image
      Fig. 1. (A, B) Axial and coronal contrast-enhanced computed tomography scans reveal a 20-mm cystic lesion in the head of the pancreas during the arterial phase, with contrast enhancement observed in the cyst wall. A 4-mm nodule with strong contrast enhancement is also detected. (C) Contrast-enhanced endoscopic ultrasound using Sonazoid reveals contrast (GE Healthcare) enhancement in the cystic wall and nodule (arrow). (D) After puncturing with a 19-gauge fine needle aspiration needle, a biopsy is performed using 0.75-mm micro biopsy forceps (Moray Micro forceps; STERIS).
      Fig. 2. (A) Biopsy specimen shows that tumor cells with round nuclei proliferated in a trabecular or alveolar pattern (hematoxylin & eosin [H&E] stain, ×10). Immunohistochemical staining is positive for chromogranin A, leading to the diagnosis of pancreatic neuroendocrine neoplasm. (B) In the loupe image of the resected specimen, a cyst with a thin capsule is observed. (C) In the magnified image of the red-framed area of the image (B) where the biopsy specimen is taken, densely proliferating tumor cells are observed in the cyst wall (H&E stain, ×100). (D) In the loupe image of immunostaining with chromogranin A, positivity is observed in the cyst wall, leading to the diagnosis of cystic degeneration of pancreatic neuroendocrine neoplasm.
      Usefulness of micro forceps biopsy for cystic degenerated pancreatic neuroendocrine neoplasm

      Clin Endosc : Clinical Endoscopy Twitter Facebook
      Close layer
      TOP