Duodenum – carcinoid tumor, with EUS FNA
This is a 54 yo female with known chronic liver disease who underwent upper GI endoscopy and a small carcinoid lesion was found in the duodenum.
On this examination we see a smooth, round, superficial, subepithelial lesion with some central dimpling. The findings are consistent with a neuroendocrine tumor of the duodenal bulb.
Endoscopic ultrasound was used to examine the area, and to our surprise we found a 1.9 cm lesion within the head of the pancreas. The ultrasound characteristics of the lesion, smooth, round, homogeneous, and isoechoic, are essentially diagnostic of a neuroendocrine tumor. The lesion appeared to be separate from the duodenal wall lesion, and on magnified views on ultrasound we can see that it is contained within the head of the pancreas.
Fine needle aspiration is being performed with a 22 gauge needle passed through the duodenal wall and into the mass. There is considerable resistance as the needle is moved to and fro within the lesion. Cytologic material is aspirated from the lesion as the needle is moved in and out of the mass lesion.
Cytologic examination of the material reveals bland appearing monotonous cuboidal cells with a fine granular cytoplasm essentially diagnostic of a neuroendocrine tumor. Chromogranin and synaptophysin stains were positive.
An additional lesion was seen in the tail of the pancreas measuring 2.7 cm. These findings were consistent with an additional neuroendocrine tumor in the tail of the pancreas. Given the multifocality of the lesions, the possibility of a MEN-1 lesion was raised.
William R. Brugge, M.D., Harvard Medical School, Massachusetts General Hospital