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DOI: 10.1055/a-1730-3973
A case of high grade pancreatic intraepithelial neoplasia diagnosed by endoscopic ultrasound-guided fine needle aspiration
Supported by: Japanese Foundation for Research and Promotion of Endoscopy http://dx.doi.org/10.13039/100018254
We report a case of high grade pancreatic intraepithelial neoplasia diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) ([Video 1]). The patient was a 68-year-old man who came for a checkup. Main pancreatic duct (MPD) dilatation was observed on abdominal ultrasonography. His tumor marker levels were normal. Contrast-enhanced computed tomography showed a dilated caudal MPD and pancreatic parenchyma atrophy, consistent with the interruption of the MPD in the pancreatic body ([Fig. 1]). Magnetic resonance cholangiopancreatography revealed caudal MPD dilatation and a small cystic lesion around the MPD stenosis. Endoscopic ultrasound (EUS) showed a faint 10-mm hypoechoic area around the pancreatic duct with indistinct borders, irregular contours, and heterogeneous internal echogenicity.
Video 1 We report a case of high grade pancreatic intraepithelial neoplasia diagnosed by endoscopic ultrasound-guided fine needle aspiration, which was difficult to diagnose using pancreatic juice cytology.
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High grade pancreatic intraepithelial neoplasia or minimally invasive carcinoma was suspected. Endoscopic pancreatography revealed a 20-mm stenosis in the MPD ([Fig. 2]); endoscopic nasopancreatic drainage and subsequent pancreatic juice cytology were performed [1]. All samples were classified as Class III. EUS-FNA was performed to evaluate the faint hypoechoic area in order to exclude malignancy ([Fig. 3]). Four punctures were performed using EZ-shot3 plus (22G; Olympus Medical Systems Corp., Tokyo, Japan). The patient developed mild pancreatitis that improved with conservative treatment.
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The pathological diagnosis was adenocarcinoma ([Fig. 4]). He underwent laparoscopic pancreatic tail resection with a preoperative diagnosis of T1aN0M0 stage I or TisN0M0 stage 0. Microscopic examination revealed papillary growth of high grade pancreatic intraepithelial neoplasia in the branch of the pancreatic duct contiguous with the MPD ([Fig. 5]). There was no invasion of the pancreatic parenchyma. The final pathological diagnosis was TisN0M0 stage 0. We speculated that tumor cells could be confirmed by EUS-FNA because of the widespread presence of the high grade pancreatic intraepithelial neoplasia in the branched pancreatic duct and the weak cell adhesion of the cancer. There has been only one previous report of high grade pancreatic intraepithelial neoplasia diagnosed by EUS-FNA [2]. We encountered a high grade pancreatic intraepithelial neoplasia case diagnosed by EUS-FNA as a rescue for negative pancreatic juice cytology.
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Competing interests
The authors declare that they have no conflict of interest.
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References
- 1 Iiboshi T, Hanada K, Fukuda T. et al. Value of cytodiagnosis using endoscopic nasopancreatic drainage for early diagnosis of pancreatic cancer: establishing a new method for the early detection of pancreatic carcinoma in situ. Pancreas 2012; 41: 523-529
- 2 Sakamoto H, Kitano M, Dote K. et al. In situ carcinoma of pancreas diagnosed by EUS-FNA. Endoscopy 2008; 40: E15-E16
Corresponding author
Publication History
Article published online:
04 February 2022
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References
- 1 Iiboshi T, Hanada K, Fukuda T. et al. Value of cytodiagnosis using endoscopic nasopancreatic drainage for early diagnosis of pancreatic cancer: establishing a new method for the early detection of pancreatic carcinoma in situ. Pancreas 2012; 41: 523-529
- 2 Sakamoto H, Kitano M, Dote K. et al. In situ carcinoma of pancreas diagnosed by EUS-FNA. Endoscopy 2008; 40: E15-E16
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