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At the time of EGD, a 2-cm, yellowish, soft, mobile, subepithelial lesion was seen at the distal end of D2, suspected to be a lipoma (Figure A). Upon biopsy attempt using cold forceps, the polypoid structure ruptured and white serous fluid gushed out of the lesion (Figure B) until it completely flattened (Figure C). The procedure was well-tolerated. The biopsy specimen was sent for pathologic ssessment. Look on page 1533 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information n submitting your favorite image to Clinical Challenges and Images in GI. Conflicts of interest: The authors disclose no conflicts. © 2011 by the AGA Institute 0016-5085/$36.00 doi:10.1053/j.gastro.2010.07.054

Question: A 20-year-old woman presented with a 1-month history of epigastric pain. She denied melena, fever, or weight loss. Her medical history was remarkable for a Crohn’s disease, first manifested during childhood age and treated medically (immunosuppression) and surgically (ileocolecteomy, 5 years earlier). Preliminary laboratory analyses revealed an elevation of serum lipase (2200 U/L). Contrast-enhanced CT scan (Figure A) showed a large hypodense mass, embedded within the pancreatic body with a 0.8-cm cyst (not shown). T2-weighted magnetic resonance imaging demonstrated a high signal intensity of this mass (Figure B), with delayed enhancement after gadolinium injection (not shown). Owing to her age, sex, and the cystic component, the patient was referred to surgery with a preoperative diagnosis of solid and pseudopapillary neoplasm. She underwent splenopancreatectomy with en bloc resection of the left colonic flexure, a part of the jejunum, and posterior gastric wall. Digestive tract reconstruction was performed. Figure C shows a gross section of this pancreatic mass, Figures D and E show a hematoxylin and eosin stained microscopic section, and Figure F shows an immunohistochemical study. Her postoperative recovery was uneventful and there was no evidence of recurrence after 15 months of follow-up. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.