Cystic pancreatic neuroendocrine tumors: correlation of in vivo needle-based confocal endomicroscopic findings by ex vivo analysis

Published:August 01, 2016DOI:
      A 30-year-old man was found to have an incidental pancreatic cystic lesion (PCL) during CT evaluation of a ureteral stone. EUS revealed a 3 cm × 2.6 cm cystic lesion with a thick wall in the pancreatic tail and 1.0 cm × 0.8 cm cystic lesions in both the uncinate and the genu of the pancreas. Needle-based confocal laser endomicroscopy (nCLE) of the tail lesion was performed with an AQ-Flex-19 miniprobe (Cellvizio; Mauna Kea Technologies Inc, Suwanee, Ga) and revealed well-demarcated clusters of cells (trabeculae) with surrounding fibrosis and vascularity (Fig. 1; Video 1, available online at FNAs of all 3 lesions were performed, and immunostains confirmed the diagnosis of a cystic pancreatic neuroendocrine tumor (PNET). The patient underwent a distal pancreatectomy and splenectomy for the larger tail lesion. Ex vivo CLE (Video 1) was performed with a Gastroflex-UHD probe (Cellvizio), and the image patterns were similar to those of in vivo nCLE. Biopsy specimens were obtained from the lesion at the foci of the ex vivo nCLE. The histopathologic features were consistent with a well-differentiated PNET. The findings correlated with the in vivo nCLE image patterns. Cystic PNETs have a unique nCLE pattern as delineated, and this case highlights the potential role of nCLE in the evaluation of PCLs.
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      Figure 1In vivo EUS-guided needle-based confocal laser endomicroscopic view of a cystic pancreatic neuroendocrine tumor showing well-demarcated clusters of cells with surrounding areas of fibrosis and vascularity.
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