US Quiz September 2020

04/09/2020   0 Comments

Case Report A 49-year-old, caucasian, healthy man underwent an abdominal ultrasound due to nonspecific abdominal complaints, which revealed an incidental finding in the uncinate process of the pancreas of a nodular area with 26×24 mm. Physical examination was normal. Laboratorial data was unchanged, namely CA 19-9. In addition, he performed other complementary diagnostic tests. Abdominal computed tomography (CT) showed a hypodense, hypovascular focal lesion in the uncinate region of the pancreas, 28 mm in diameter, without Wirsung dilation. Magnetic resonance imaging (MRI) with cholangiography revealed a cystic image with heterogeneous content in the uncinate process, measuring 30 mm, with thickened walls, contacting the terminal portion of the pancreatic duct without dilatation (Fig. 1).  Endoscopic ultrasonography (EUS) identified in the uncinate process, a cystic lesion of 26 mm, with solid content, marked wall thickening and increased peripheral vascularization. No communication with the Wirsung duct, nor vascular invasion was detected. Fine needle aspiration (FNA) of the cyst and biopsy of the wall with micro forceps through the 19G needle were also performed (Fig. 2 and 3) (Video 1). Quiz Discussion The cytohistological description revealed monomorphic cells showing with little cohesion and with scarce, clarified or eosinophilic cytoplasm, sometimes foamy, and round to oval nuclei with indistinct nucleoli. The cells were organized in solid aggregates and in a slightly radial arrangement around fibrovascular axis (Fig. 4). The results of the immunohistochemical study were positive for vimentin (diffuse), beta-catenin (nuclear and cytoplasmic) and negative for chromogranin and estrogen receptors (Fig. 5). The pathology final report made the diagnosis […]

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