Endoscopic ultrasound-guided fine needle aspiration of solid pseudopapillary tumors of the pancreas: a report of three cases
A 31-year-old female was diagnosed with a pancreatic mass, which was found on an abdominal computed tomography (CT) scan performed during an examination for chronic liver disease. The physical examination was unremarkable. On admission, laboratory results were all within the normal reference ranges: white blood cell (WBC) count, 5.68 × 103/µL; hemoglobin, 11.8 g/dL; platelets, 188 × 103/µL; total bilirubin, 0.4 mg/dL; aspartate aminotransferase (AST)/alanine aminotransferase (ALT), 37/19 U/L; amylase/lipase, 84.0/84.6 U/L; carbohydrate antigen (CA) 19-9, 7.59 U/mL.\nAn abdominal CT scan showed an ovoid, slightly hypoattenuating, 2.4-cm mass with accompanying distal pancreatic duct dilatation in the body of the pancreas. Magnetic resonance imaging (MRI) demonstrated a well-circumscribed, round mass with mild upstream duct dilatation. Hypervascularity then delayed enhancement was noted during the arterial phase, which was interpreted as suspicious for SPT. During the EUS exam, an approximately 3-cm, well demarcated, homogenously isoechoic mass was observed in the neck of the pancreas. The tumor compressed the pancreatic vein and pancreatic duct but there was no evidence of invasion into the surrounding tissues.\nEUS-FNA was performed three times using a 25-gauge needle without complications. Materials were smeared on glass slides, and then fixed immediately in 95% alcohol for hematoxylin and eosin (H&E) and Papanicolaou stains. Additional aspirate materials were used for preparation of the cell block, which was fixed in formalin.\nThe samples showed some cell nests with branching papillary features composed of fibrovascular cores and microadenoid structures ( and ). These findings were strongly suggestive of SPT. We recommended surgery, but the patient rejected surgical resection before being discharged.