Stacy Prall, D'O' Gastroenterology Fellow

1
Stacy Prall, D.O.Gastroenterology Fellow

• Resident Research Day
• Geisinger Medical Center
• May 18, 2007

2
Endoscopic Ultrasound A Useful Tool to Diagnose
Masqueraders of Pancreatic Cancer
3

• The role of endoscopic ultrasound (EUS) continues
  to expand. EUS combined with fine needle
  aspiration biopsy (EUS-FNAB) is becoming the
  preferred mode of staging pancreatic, esophageal,
  and mediastinal malignancies. EUS continues to
  gain favor in distinguishing between pancreatic
  lesions and extra-intestinal lymphomas
  specifically peripancreatic, ampullary, and
  periduodenal masses. The aforementioned lesions
  often mimic pancreatic tumors on alternative
  imaging modalities like CT scans.

4

• According to the National Cancer Institute (NCI)
  pancreatic cancer now represents the fourth
  leading cause of cancer related death in males
  and the fifth in females (http//seer.cancer.gov).
  Distinguishing between pancreatic malignancies
  and peri-intestinal malignancies is crucial for
  treatment options and prognosis.

5

• We report three cases of presumed pancreatic
  masses referred to Geisinger Medical Center for
  EUS diagnosis and staging. EUS revealed
  extra-intestinal lymphoma in all 3 cases.

6
Case 1

• 66 year old female presented with weight loss and
  abdominal pain. CT done at outside hospital
  revealed 5.4 cm pancreatic head mass. EUS-FNAB
  demonstrated a paraduodenal mass in the region of
  the pancreatic head consistent with follicular
  lymphoma, grade 2.

7
(No Transcript)
8
Case 2

• 47 year old male presented with abdominal pain
  and weight loss. CT revealed abnormally
  enlarged body and tail, fullness at the
  pancreatic head with encasement of the splenic
  artery concerning for malignancy.

9
Pancreatic body and tail abnormal enlargement,
head prominent. Concerning for pancreatic
malignancy
10
EUS FNA demonstrated peri-pancreatic lymphoma
11
Case 3

• 74 year old male presented with weight loss and
  fevers. CT performed at outside hospital
  revealed a 4 cm lateral pancreatic head mass on
  CT. EUS with FNAB revealed peripancreatic
  Non-Hodgkins B cell lymphoma.

12
(No Transcript)
13

• Data on EUS-FNA sensitivity, specificity, and
  accuracy in diagnosing lymphoma is limited.
  Recent studies report EUS-FNA sensitivity and
  specificity to be 96-100, 77-95 in lymphomas.1
  The importance of cellular adequacy in diagnosing
  lymphoma is critical.

14

• EUS coupled with FNAB affords the clinician an
  accurate minimally invasive diagnostic technique.
  EUS-FNA sampling typically requires several
  needle passes to provide adequate sample size. In
  our cases series all specimens were adequate for
  diagnosis.

15

• Extra-intestinal lymphomas traditionally required
  surgery or CT-FNAB for diagnosis and staging.
  EUS-FNAB appears poised to replace this practice
  allowing for rapid accurate diagnosis upon which
  treatment can be based. The 3 patients in our
  case series all received chemotherapy with good
  clinical response 1 to 2 years from the time of
  initial diagnosis

16
References

• Pugh JL. Jhala NC. Eloubeidi MA. Chhieng DC.
  Eltoum IA. Crowe DR. Varadarajulu S. Jhala DN.
  Diagnosis of deep-seated lymphoma and leukemia by
  endoscopic ultrasound-guided fine-needle
  aspiration biopsy. Journal Article American
  Journal of Clinical Pathology. 125(5)703-9, 2006
  May