Pancreatic cystic lesion: Appearances can be deceptive (with video)!

Competing Interests: Disclosure All authors disclosed no financial relationships. Commentary The diagnostic accuracy of differentiating benign from malignant pancreatic cystic lesions is suboptimal, dependent on imaging in combination with cyst fluid markers and cytologic analysis, and more recently molecular markers. All modalities are often considered in combination to make the best assessment. In this case, a patient underwent EUS-FNA of a 2-cm pancreatic cyst because of the alarm feature of a mural nodule. Fluid analysis markers suggested the lesion to be benign, with high glucose and amylase levels and a low carcinoembryonic antigen. However, cytologic analysis revealed the presence of tumor cells from the mural nodule sampling consistent with neuroendocrine tumor. This case nicely illustrates the necessity of using multiple modalities for the diagnosis of pancreatic cysts, inasmuch as fluid analysis alone is not adequate for accurate diagnosis. Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points