May 2019 — Cytopathology

A 57-year-old woman with a history of cholecystectomy presents to the emergency room with sharp epigastric pain penetrating through to her back. She was hospitalized at that time for three days and found to have elevated pancreatic enzymes. Her imaging showed extensive pancreatic calcification, with small popcorn-type distribution throughout the gland, consistent with chronic pancreatitis. Her abdominal MRI showed innumerable pancreatic cysts throughout the pancreas, with the largest measuring at least 2.2 cm at the pancreatic head. No dilatation of the main pancreatic duct (Figure 1). The radiological differential diagnosis was multifocal branch intraductal papillary mucinous neoplasm (IPMN). The patient underwent endoscopic ultrasound fine needle aspiration (EUS/FNA) (Figure 2 A-D). Her pancreatic cyst amylase was 284110 I/U, and CEA was 145.

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Photo of Sam T. Albadri, M.B., Ch.B., M.S. Sam Albadri, M.B., Ch.B., M.S.
Fellow, Cytopathology
Mayo Clinic
Photo of Longwen Chen, M.D., Ph.D. Longwen Chen, M.D., Ph.D.
Consultant, Anatomic Pathology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

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