Abnormal pancreas in a 9 yr old DSH

      • Weight loss and intermittent anorexia since July 2021. No vomiting or diarrhea.
      • Mild hyperglycemia, mild persistent ALP elevation
      • Abdominal ultrasound shows an enlarged, hypoechoic, pancreas with an irregular capsule and adjacent echogenic fat.  The liver shows increased echogenicity.  The gallbladder has a thickened, echogenic wall. The spleen is rounded in shape with normal parenchyma.
      • US guided FNA was performed on the liver and pancreas.  Liver cytology shows mild to moderate hepatic lipidosis.  
      • Pancreatic cytologys shows: “Minimally atypical pancreatic tissue without evidence of inflammation or necrosis;These results suggest a benign pancreatic nodular hyperplasia. A well differentiated pancreatic adenocarcinoma could be possible, but I would expect a mass lesion to be present rather than a more diffuse enlargement. If you clinically suspect carcinoma to be more likely and there is no obvious dissemination in the thorax or abdomen that would preclude surgical excision, please consider histopathological analysis.”
      • Just wondering what your thoughts are on this pancreas…Thanks!

5 responses to “Abnormal pancreas in a 9 yr old DSH”

  1. I would be concerned about

    I would be concerned about pancreatic neoplasia. Would not expected nodular hyperplasia to result in the presenting clinical signs. Needs a Tru-cut/wedge biopsy for a specific answer.

  2. I agree on the tru cut bx on

    I agree on the tru cut bx on this one ideally but fna may give some info. There is an inflammatory pattern around the capsule.

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