Thorlacius Henrik, Kalaitzakis Evangelos, Johansson Gabriele Wurm, Ljungberg Otto, Ekberg Olle, Toth Ervin
Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, 20502, Sweden.
BMC Res Notes. 2014 Aug 9;7:510. doi: 10.1186/1756-0500-7-510.
Pancreatic neuroendocrine tumors are typically solid neoplasms but in very rare cases present as cystic lesions. The diagnosis of cystic tumors in the pancreas is extremely difficult and the use of endoscopic ultrasound and fine-needle aspiration might be helpful in the work-up of patients with cystic neuroendocrine tumors in the pancreas.
A 78-year-old Caucasian man was admitted with a history of epigastric pain. Laboratory tests were normal. The patient underwent transabdominal ultrasound, computed tomography and magnetic resonance cholangiopancreatography demonstrating an unclear cystic mass in the head of the pancreas. The patient was referred for endoscopic ultrasound. Endoscopic ultrasound showed a hypoechoic lesion (42 × 47 mm) in the head of the pancreas with regular borders and large cystic components. The main pancreatic duct was normal without any connection to the cystic process. The lesion underwent fine-needle aspiration (22 Gauge). Cytological examination demonstrated cohesive groups of plasmacytoid cells staining positively for synaptophysin and chromogranin A, which is suggestive of a neuroendocrine tumor.
Differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology, such as computed tomography and magnetic resonance imaging. This unusual case with a pancreatic cystic neuroendocrine tumor highlights the clinical importance of endoscopic ultrasound in the work-up of patients with unclear lesions in the pancreas.
胰腺神经内分泌肿瘤通常为实性肿瘤，但极少数情况下表现为囊性病变。胰腺囊性肿瘤的诊断极其困难，内镜超声和细针穿刺检查可能有助于胰腺囊性神经内分泌肿瘤患者的检查。
一名78岁的白人男性因上腹部疼痛病史入院。实验室检查正常。患者接受了经腹超声、计算机断层扫描和磁共振胰胆管造影，结果显示胰腺头部有一个不明确的囊性肿块。患者被转诊进行内镜超声检查。内镜超声显示胰腺头部有一个低回声病变（42×47毫米），边界规则，有大量囊性成分。主胰管正常，与囊性病变无任何连通。对该病变进行了细针穿刺（22号）。细胞学检查显示浆细胞样细胞呈聚集状，突触素和嗜铬粒蛋白A染色阳性，提示为神经内分泌肿瘤。
使用计算机断层扫描和磁共振成像等传统放射学方法对胰腺囊性病变进行鉴别诊断非常困难。这例胰腺囊性神经内分泌肿瘤的罕见病例凸显了内镜超声在胰腺病变不明确患者检查中的临床重要性。
