2020 Volume 35 Issue 6 Pages 583-591
A 47-year-old man presented with a mass in the pancreatic tail diagnosed by transabdominal ultrasonography. A contrast-enhanced CT scan showed a 15mm mass with central calcifications which gradually enhanced from early to late phases. Based on endoscopic ultrasonography imaging, the mass was hyperechoic mainly in the central area despite the margin being hypoechoic. Based on imaging studies, a solid-pseudopapillary neoplasm (SPN) and pancreatic neuroendocrine tumor were considered in the differential diagnosis. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) was performed, followed by hematoxylin-eosin staining and immunostaining, to definitively establish the diagnosis of SPN. We performed a distal pancreatectomy, and the mass was histologically confirmed to be an SPN from the resected specimen. In this patient, diagnosis using imaging studies alone was inconclusive since the mass had an atypical internal echo by ultrasonography. Therefore, EUS-FNA played a relatively important role in the preoperative diagnosis of SPN for this mass lesion with atypical ultrasonographic findings.
