INTRACYSTIC GLUCOSE AND CEA MEASUREMENT: A QUICK AND ACCURATE TOOL FOR DIAGNOSING MUCINOUS PANCREATIC CYSTS

A 47 years old female patient presented to our gastroenterology department for evaluation of a pancreatic cystic lesion. She had had a drowning accident 1 month before. A thoracic CT scan was performed, with the incidental finding of a lesion (30 × 26 mm) located in the head of the pancreas. Abdominal MRI confirmed its presence and localization. At consultation, she declared having no symptoms. Known for hypertension and asthma, she had neither personal nor family history of pancreatic disease. She was a non-smoker and an occasional alcohol consumer. Liver tests and lipase were normal. We decided to perform an endoscopic ultrasound (EUS) that revealed a multilocular cystic lesion measuring 33 × 20 mm and containing multiple septa, localized at the level of the pancreatic head. There was no visible communication with the pancreatic duct. A hypoechoic intracystic nodular structure of 4 mm was identified on the wall of one of the peripheral loci. EUS-contrast agent injection allowed us to exclude the presence of any microvascularisation, supporting the hypothesis of a mucus clot. Intracystic fluid was then collected by EUS-guided fine-needle aspiration. The string test was negative. The fluid's CEA and glucose were measured at 217 ug/L and 3.7 mg/dL, respectively. This was consistent with mucinous cystadenoma based on recently published cut-off values and cytological analysis supported this diagnosis. Following the European Expert Consensus of 2013, we scheduled a control MRI every 6 months for one year.

Latest studies suggest that the measurement of both intracystic CEA and glucose is useful in diagnosing mucinous cysts with sensitivity close to 100%. In this report, we present a case in which accurate diagnosis was proposed using this tool in combination with a positive cytology.