2021 Volume 36 Issue 5 Pages 339-347
A 15-year-old male was found to have a posterior mediastinal tumor and low-attenuation mass in the pancreatic head on computed tomography (CT) scan. The masses did not enhance between the arterial and venous phases. A hypoechoic mass was seen in the pancreas on endoscopic ultrasound (EUS) and EUS-guided fine needle biopsy (EUS-FNB) using a Franseen needle was performed. The biopsy specimen contained a proliferation of spindle-shaped cells with scattered mature ganglion cells. Immunocytochemistry showed positive staining with S-100 protein in spindle-shaped cells and with synaptophysin in ganglion cells. CT scan guided needle biopsy of the posterior mediastinal tumor was performed and the same histological and immunocytochemical findings obtained. The definitive diagnosis was a pancreatic ganglioneuroma (GN) and posterior mediastinal GN and he underwent a follow-up examination. GN is a rare benign soft tissue tumor that arises from sympathetic nerve fibers, frequently discovered during childhood or in young adults and pancreatic GN are exceedingly rare. This is the first case report of a pancreatic GN diagnosed by EUS-FNB based on our literature search. Recently, an EUS-FNB needle was developed with improved core tissue procurement, allowing for immunohistochemistry required for diagnosis. EUS-FNB may be useful for evaluation of an unusual pancreatic mass such as in the present patient.
