Hypervascular pancreatic tumor diagnosed as a serous cystadenoma by EUS-guided Trucut biopsy

At the Focal Point

Commentary It is well known that patients may give a history of having had a cholecystectomy, while the surgeon finds a gallbladder remnant to account for symptoms. Gallbladder remnant, first reported in 1936 by Beye, results from incomplete definition of the cystic-choledochal junction, either for good or inappropriate reasons. A calculus-inflamed gallbladder or cystic duct remnant presents with the same clinical picture and surgical problems as does the previously unmolested gallbladder, except treatment may be more difficult because of adhesions and altered anatomy. Endoscopic therapy is a valuable addition to the nonendoscopic means of treatment including dissolution therapy, extracorporeal lithotripsy, and percutaneous cholecystostomy. A job well done. Lawrence J. Brandt, MD Associate Editor for Focal Points

Hypervascular pancreatic tumor diagnosed as a serous cystadenoma by EUS-guided Trucut biopsy

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Volume 64, No. 2 : 2006 GASTROINTESTINAL ENDOSCOPY 273

At the Focal Point

This showed a lesion in the pancreatic body measuring 20 mm  16 mm, which had a mixed solid and microcystic appearance resembling a ‘‘honeycomb pattern’’ as described in serous cystadenomas (B). Power Doppler imaging demonstrated intense vascularity (C). EUS-guided Trucut biopsy (Quick-Core needle, Cook Endoscopy, Winston-Salem, NC) was performed to rule out a neuroendocrine tumor and metastatic renal cell carcinoma. Histologic examination demonstrated cystic spaces lined by cuboidal cells (H&E, orig. mag. 400) (D) that stained positive for cytokeratin (orig. mag. 600) (E). The diagnosis was serous cystadenoma. The patient’s weight loss was attributed to reduced oral intake because of the depressive episode. He improved significantly after treatment with antidepressive medication.

DISCLOSURE A 77-year-old man was hospitalized for a major depressive episode and weight loss. A contrast computed tomographic scan of the abdomen was performed to rule out malignancy; it revealed an enhancing tumor in the pancreatic body (A). EUS with a curved linear-array echoendoscope (EG-3830UT, PENTAX of America, Montvale, NJ) was performed for further evaluation of the pancreatic mass.

None of the authors have any disclosure to make. Henning Gerke, MD, Rogelio Silva, MD, Chris S. Jensen, MD, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA doi:10.1016/j.gie.2006.01.038

Commentary The use of EUS–Trucut biopsy as a diagnostic tool is evolving, and its role compared with that of fine-needle aspiration (FNA) is being studied. Because serous cystadenoma was suspected by EUS, perhaps diagnosis could have been made with FNA and evaluation of the aspirated fluid, particularly the cancinoembryonic antigen and amylase levels. Why the lesion was so vascular is perplexing to me, but the use a Trucut needle to sample an ‘‘intensely vascular’’ lesion seems unwise because of the risk of bleeding; FNA appears to me more rational, but maybe I am wrong. As has been said, good judgment comes from experience and experience comes from bad judgment. Time will tell. Lawrence J. Brandt, MD Associate Editor for Focal Points

274 GASTROINTESTINAL ENDOSCOPY Volume 64, No. 2 : 2006

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