Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2018; 10(7): 125-129
Published online Jul 16, 2018. doi: 10.4253/wjge.v10.i7.125
Diagnosis of intraductal papillary mucinous neoplasm using endoscopic ultrasound guided microbiopsies: A case report
Charlotte Vestrup Rift, Bojan Kovacevic, John Gásdal Karstensen, Julie Plougmann, Pia Klausen, Anders Toxværd, Evangelos Kalaitzakis, Carsten Palnæs Hansen, Jane Preuss Hasselby, Peter Vilmann
Charlotte Vestrup Rift, Jane Preuss Hasselby, Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
Bojan Kovacevic, John Gásdal Karstensen, Julie Plougmann, Pia Klausen, Evangelos Kalaitzakis, Peter Vilmann, Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Herlev 2730, Denmark
John Gásdal Karstensen, Gastro Unit, Division of Surgery, Copenhagen University Hospital, Hvidovre, 2650 Hvidovre, Denmark
Anders Toxværd, Department of Pathology, Copenhagen University Hospital Herlev and Gentofte, Herlev 2730, Denmark.
Carsten Palnæs Hansen, Department of Gastrointestinal surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen 2100, Denmark
Author contributions: Rift CV performed the microscopic evaluation and NGS-analysis of the tissue, and wrote the manuscript in equal collaboration with Kovacevic B, who also obtained written consent from the patient; Hasselby JP and Toxværd A provided laboratory and facilities as well as assistance in the tissue analysis; Klausen P coordinated and provided the collection of the tissue; Vilmann P performed the EUS and obtained the microbiopsy; Kalaitzakis E, Karstensen JG, Plougmann J and Hansen CP were involved in editing the manuscript.
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: John Gásdal Karstensen, MD, PhD, Doctor, Postdoctoral Fellow, Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev and Gentofte, Herlev Ringvej 75, Herlev 2730, Denmark. john.gasdal.karstensen.01@regionh.dk
Telephone: +45-40-944465 Fax: +45-38-684009
Received: March 22, 2018
Peer-review started: March 23, 2018
First decision: April 13, 2018
Revised: April 27, 2018
Accepted: June 8, 2018
Article in press: June 9, 2018
Published online: July 16, 2018
Processing time: 116 Days and 12.4 Hours
Abstract

Pancreatic cysts are increasingly diagnosed due to expanding use of cross-sectional imaging, but current diagnostic modalities have limited diagnostic accuracy. Recently, a novel through-the-needle microbiopsy forceps has become available, offering the possibility of obtaining cyst-wall biopsies. We present a case of 41-year-old male with chronic pancreatitis and a 2-cm pancreatic cyst, initially considered a pseudocyst. Subsequently, endoscopic ultrasound guided microbiopsies were successfully obtained, which surprisingly revealed an intraductal papillary mucinous neoplasm of mixed subtype with low grade dysplasia. In conclusion, obtaining biopsies from the wall of the pancreatic cystic lesions with this novel instrument is feasible and, as demonstrated in this case, can possibly alter the clinical outcome. Microbiopsies offered enough cellular material, allowing supplemental gene mutation analysis, which combined with other modalities could lead to a more individual approach when treating pancreatic cysts. However, prospective studies are warranted before routine clinical implementation.

Keywords: Microbiopsy; Pancreatic cyst; Endoscopic ultrasound-fine needle aspiration; Intraductal papillary mucinous neoplasm; Chronic pancreatitis

Core tip: We present a case of a pancreatic cyst with an initial diagnosis of a pseudocyst altered to an intraductal papillary mucinous neoplasm of mixed type with low grade dysplasia through the use of endoscopic ultrasound guided microbiopsies obtained with a novel through-the-needle microbiopsy forceps, rendering the possibility of microscopic evaluation and genetic analysis of the cyst.