Abstract
Question: A 74-year-old man presented with vague abdominal pain. There was no personal history of malignancy or weight loss. Serum laboratory tests were significant for a total bilirubin of 3.4 mg/dL but direct bilirubin of 0.20 mg/dL. Liver enzymes, lactate dehydrogenase, carcino-embryonic antigen, and cancer antigen 19-9 were all within normal range. Computed tomographic (CT) imaging (Figure A and B) revealed a 6 × 2.9 × 2.7 cm pancreatic mass in the body of the pancreas with associated mesenteric and left-side retro-peritoneal para-aortic lymphadenopathy without significant ductal dilation. Endoscopic ultrasound (EUS) examination (Figure C and D) demonstrated a nearly completely cystic mass measuring 2.5 × 2.2 cm. A plane appeared to separate the cystic mass from the pancreatic body itself. Multiple abnormal, oval, hypo-echoic lymph nodes were visualized in the peri-gastric region as well. EUS-guided core biopsies were obtained from the cyst wall.
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