Evaluation of EUS and serial pancreatic juice aspiration cytological examination in a case of pancreatic carcinoma in situ

Abstract

A 65-year-old man was admitted to our hospital with mild acute pancreatitis. Contrast enhanced CT and MRI revealed dilatation of the main pancreatic duct as well as the branch ducts at the pancreatic tail. Endoscopic ultrasonography depicted an anechoic region considered as expansion of the branch ducts, and a 10mm hypoechoic region which could not be recognized as a solid tumor. ERP confirmed the main pancreatic duct stenosis and serial pancreatic juice aspiration cytological examination (SPACE) revealed atypical cells. Thus the patient was diagnosed as pancreatic carcinoma, therefore, surgical resection was performed. Histological examination of the surgical specimen revealed that carcinoma in situ was present in the branch duct close to the stenosis of the main pancreatic duct. The hypoechoic region on the endoscopic ultrasonography appeared to represent an indirect image finding of pancreatic carcinoma in situ. Thus, in such instances, SPACE can facilitate the diagnosis of pancreatic carcinoma in situ.