1. Pancreatic Tumors Unknown Cases.
Mostafa Fraig, MD

2. Case 1: History
Sixty Seven year-old male with a history of chronic pancreatitis who presented to his local Gastroenterologist with an obstructive jaundice. He was found to have a common bile duct stricture and had a stent inserted, which relieved his obstructive symptoms. He was referred for an EUS evaluation and possible FNA biopsy.
An ERCP was performed and the common bile duct brushings are in image 1A and 1C.

3. Case 1: History, cont’d
On EUS evaluation, there was a homogenous mass in the head of the pancreas. The mass measured 1.2 X 1.0cm..
What is your differential diagnosis, based on the different stages in the diagnosis?
At what point are you willing to diagnose cancer in this timeline?
What are the other ancillary studies that could help in supporting your diagnosis?

4. 1A 1A

5. 1B 1B

6. 1C 1C

7. 1D

8. 1E

9. 1F

10. 1G

11. 1-I

12. 1J

13. Case 2: History
58 Year old female who had a history of kidney stones. During her work up, a mass that measured 2.2X 1.5 CM is detected in the tail of the pancreas. It has a well defined borders on EUS and CT.
What is your differential diagnosis?
What would you do on site to help you sort out that differential diagnosis?

14. Case 2: History, cont’d
What ancillary studies would you perform to confirm your diagnosis?

15. 2A

16. 2B

17. 2C

18. 2D

19. 2E

20. 2F

21. Case 3: History
A 62 year-old male patient is presenting with distal common bile duct stricture. He was sent for EUS evaluation and found to have a mass in the main pancreatic duct that is communicating with the main duct lumen and extends into the CBD.
What is your differential diagnosis?
What are the distinctive features for the preferred diagnosis?

22. Case 3: History, cont’d
What would you procure for ancillary testing in this specimen?
What are the ancillary tests that helps in confirming the diagnosis?
The images from the resected specimen are in 3F
What are the criteria for the diagnosis of invasion in this type of tumors?

23. 3A

24. 3B

25. 3C

26. 3D

27. 3E

28. 3F

29. Case 4: History
A 71 year old male with history of chronic pancreatitis is presenting with an obstructive jaundice and a mass in the head of the pancreas. EUS evaluation shows a solid mass with ill-defined edges extending into the peri-pancreatic fat.
What is the differential diagnosis.

30. 4A

31. 4B

32. 4C

33. Cell block

34. Case 5: History
A 58 year-old female presented with jaundice and a mass in the head of the of pancreas. On EUS evaluation there was a cystic mass measuring 3.8X 2.2 CM multilocular cyst. An FNA biopsy revealed few epithelial cells.
What is you differential diagnosis?
What are the criteria for malignancy?

35. Case 5: History, cont’d
What are the ancillary tests that could help in narrowing down the differential diagnosis?

36. 5A

37. 5B

38. 5C

39. 5D

40. 5E

41. Case 6: History
A 34 year old female presented with a 1.4CM in diameter well defined mass in the body of the pancreas.
What is your differential diagnosis?
How to narrow down this differential?
Images from the resection specimen are shown in 6E.
What is the diagnosis?

42. Case 6: History, cont’d
What ancillary studies would you use to confirm your diagnosis?

43. 6A

44. 6B

45. 6C

48. Thank You