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Area of Science:

• Gastroenterology
• Surgical Pathology
• Diagnostic Imaging

Background:

• A 60-year-old male with a history of recurrent acute pancreatitis (AP) presented with frequent attacks.
• Previous endoscopic ultrasonography (EUS) identified a pancreatic body cyst with a nodule and main pancreatic duct (MPD) dilation, initially suggesting branch duct intraductal papillary mucosal neoplasms.

Purpose of the Study:

• To evaluate the diagnostic accuracy of endoscopic ultrasonography (EUS) in characterizing pancreatic cysts.
• To investigate the discrepancy between pre-operative EUS findings and post-operative pathological examination of a pancreatic cyst.

Main Methods:

• Serial endoscopic ultrasonography (EUS), computed tomography (CT), and magnetic resonance imaging (MRI) were performed.
• Fine-needle aspiration (FNA) was conducted for cytological analysis.
• Endoscopic retrograde cholangiopancreatography (ERCP) was used to assess the main pancreatic duct (MPD).
• Distal pancreatectomy was performed, and the resected specimen was examined by the endosonographer.

Main Results:

• Despite initial EUS findings of a 20 mm cyst with a nodule and MPD dilation (4-6 mm), the cyst showed no progression from 2011 to 2013.
• ERCP revealed a dilated MPD (5-7 mm) and a 15 mm × 13 mm cyst, leading to distal pancreatectomy due to "worrisome EUS features."
• Post-operative examination of the resected specimen showed a 3 cm cyst with a "sand glass" appearance, differing significantly from pre-operative EUS assessments.

Conclusions:

• Endoscopic ultrasonography (EUS) is a valuable tool for pancreatic cyst evaluation but may have limitations in precise characterization.
• Correlation of EUS findings with surgical specimens is crucial for refining diagnostic accuracy and understanding pancreatic neoplasm behavior.
• The discrepancy highlights the importance of integrating imaging, clinical presentation, and pathological feedback for optimal patient management.