Michael J. Levy, Thomas C. Smyrk, Raghuram P. Reddy, Jonathan E

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Endoscopic Ultrasound–Guided Trucut Biopsy of the Cyst Wall for Diagnosing Cystic Pancreatic Tumors Michael J. Levy, Thomas C. Smyrk, Raghuram P. Reddy, Jonathan E. Clain, Gavin C. Harewood, Michael L. Kendrick, Randall K. Pearson, Bret T. Petersen, Elizabeth Rajan, Mark D. Topazian, Kenneth K. Wang, Maurits J. Wiersema, Tony E. Yusuf, Suresh T. Chari Clinical Gastroenterology and Hepatology Volume 3, Issue 10, Pages 974-979 (October 2005) DOI: 10.1016/S1542-3565(05)00408-8 Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 1 Positioning of the trucut biopsy needle so that the specimen tray overlaps a portion of the cyst wall as well as adjacent pancreatic parenchyma. Clinical Gastroenterology and Hepatology 2005 3, 974-979DOI: (10.1016/S1542-3565(05)00408-8) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 2 (A) A 43-year-old woman presenting with back pain underwent abdominal computed tomography scan and was found to have a 2.0 × 3.0 cm pancreatic body cyst. It was unclear whether it represented a mucinous or nonmucinous lesion, and she was referred for resection. EUS FNA and cyst fluid analysis revealed a CEA level of 1.8 ng/mL and nondiagnostic cytology. (B) EUS TCB demonstrated classic histologic features of an SCA, obviating the need for surgery in favor of conservative management. Clinical Gastroenterology and Hepatology 2005 3, 974-979DOI: (10.1016/S1542-3565(05)00408-8) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 3 A 50-year-old man with chronic pancreatitis caused by alcohol was found to have a dilated main pancreatic duct and a cyst in the pancreatic body/tail that was believed to represent a pseudocyst. Follow-up computed tomography scan demonstrated increased cyst size, wall thickening, and inflammation, raising concern for a cystic neoplasm. EUS identified focal wall thickening within what was believed to be a pseudocyst or less likely side branch IPMN. The cyst fluid CEA level was 54.2 ng/mL, and the amylase level was 7142 U/L. The EUS TCB specimen was reported as “disintegrated” and not suitable for review. With conservative care, the cyst has completely resolved. The clinical course and new radiographic findings support the diagnosis of a pseudocyst. Clinical Gastroenterology and Hepatology 2005 3, 974-979DOI: (10.1016/S1542-3565(05)00408-8) Copyright © 2005 American Gastroenterological Association Terms and Conditions