Mostafa Fraig, MD

Pancreatic Tumors Unknown Cases.

Case 1: HistorySixty Seven year-old male with a history of

chronic pancreatitis who presented to his local Gastroenterologist with an obstructive jaundice. He was found to have a common bile duct stricture and had a stent inserted, which relieved his obstructive symptoms. He was referred for an EUS evaluation and possible FNA biopsy.

An ERCP was performed and the common bile duct brushings are in image 1A and 1C.

Case 1: History, cont’dOn EUS evaluation, there was a

homogenous mass in the head of the pancreas. The mass measured 1.2 X 1.0cm..

What is your differential diagnosis, based on the different stages in the diagnosis?

At what point are you willing to diagnose cancer in this timeline?

What are the other ancillary studies that could help in supporting your diagnosis?

1A1A

1B

1B

1C1C

1D

1E

1F

1G

1-I

1J

Case 2: History58 Year old female who had a history of

kidney stones. During her work up, a mass that measured 2.2X 1.5 CM is detected in the tail of the pancreas. It has a well defined borders on EUS and CT.

What is your differential diagnosis?What would you do on site to help you

sort out that differential diagnosis?

Case 2: History, cont’d What ancillary studies would you perform to confirm your diagnosis?

2A

2B

2C

2D

2E

2F

Case 3: History

A 62 year-old male patient is presenting with distal common bile duct stricture. He was sent for EUS evaluation and found to have a mass in the main pancreatic duct that is communicating with the main duct lumen and extends into the CBD.

What is your differential diagnosis?What are the distinctive features for the

preferred diagnosis?

Case 3: History, cont’dWhat would you procure for ancillary

testing in this specimen?What are the ancillary tests that helps in

confirming the diagnosis?The images from the resected specimen

are in 3FWhat are the criteria for the diagnosis of

invasion in this type of tumors?

3A

3B

3C

3D

3E

3F

Case 4: HistoryA 71 year old male with history of

chronic pancreatitis is presenting with an obstructive jaundice and a mass in the head of the pancreas. EUS evaluation shows a solid mass with ill-defined edges extending into the peri-pancreatic fat.

What is the differential diagnosis.

4A

4B

4C

Cell block

Case 5: HistoryA 58 year-old female presented with

jaundice and a mass in the head of the of pancreas. On EUS evaluation there was a cystic mass measuring 3.8X 2.2 CM multilocular cyst. An FNA biopsy revealed few epithelial cells.

What is you differential diagnosis?What are the criteria for malignancy?

Case 5: History, cont’dWhat are the ancillary tests that could help

in narrowing down the differential diagnosis?

5A

5B

5C

5D

5E

Case 6: HistoryA 34 year old female presented with a

1.4CM in diameter well defined mass in the body of the pancreas.

What is your differential diagnosis?How to narrow down this differential?Images from the resection specimen are

shown in 6E.What is the diagnosis?

Case 6: History, cont’dWhat ancillary studies would you use to

confirm your diagnosis?

6A

6B

6C

Thank You