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• W2920830952 abstract "A 40-year-old Caucasian woman with no significant history was referred for an EUS. She initially presented with acute epigastric pain radiating into the back that improved after changing her diet. EGD showed esophagitis and she was treated for H.pylori. A CT was obtained that revealed an abdominal mass. A CT with pancreatic protocol further defined this mass to have multiple cystic components but appeared to be exophytic to the pancreas yet defined it as possibly pancreatic cystic neoplasm. Another CT suggested that the heterogeneous mass that is located between the stomach and pancreas likely represents a gastrointestinal Stromal tumor. An EUS with a linear echoendoscope placed in the stomach easily identified the mass in the retroperitoneum as having both solid and cystic components. It could be seen abutting the pancreas but was clearly not arising from the pancreatic parenchyma or from the stomach. Under Doppler guidance, two passes were made with 22G FNA needle into the solid component of the lesion and then 4cc of blood aspirate obtained from the cystic region. The patient tolerated the procedure well with stable blood pressure throughout and during careful monitoring in the recovery area. She received three days of antibiotics post procedure. Cytology of the solid component was positive for an epithelial neoplasm. Immunohistochemical analysis showed tumor cells positive for AE1/AE3, CK 7, chromogranin, CD 56, and synaptophysin and negative for S100. With this in mind, the differential diagnosis was narrowed to a paraganglioma. Total 24-hour urine metanephrines were 196 (range 182-739), total 24-hour urine nor-metanephrine was 133 (range 88-649). A paraganglioma is a pheochromocytoma that arises outside of the adrenal medulla. It is a rare neoplasm with an incidence of 2-8 cases per million people per year. Functional paragangliomas may present with fluctuating hypertension, headache, palpitations and sweating: symptoms consistent with active secretion of catecholamines. Diagnostic dilemmas occur at the time of EUS with a paraganglioma as approximately only 10-14% of patients with a paraganglioma are asymptomatic, that may have precipitating symptoms, such as severe hypertension after FNA. Our patient, fortunately, did not experience any symptoms of catecholamine release and continues to do well after definitive laparoscopic resection.2167_A Figure 1. Immunohistochemical analysis showing tumor cells positive for chromogranin, medium power. EUS-FNA sample.2167_B Figure 2. Coronal view of Computed tomography image revealing a 2.2 x 4.7 x 4.6 cm heterogeneous appearing soft tissue mass between the stomach and pancreas2167_C Figure 3. sharply circumscribed global mass measuring 6 x 4.5 x 3.2cm and weighing 15 grams. The mass had an outer surface that has a dark-brown to black capsule, inked black. Serial sections revealed a variegated appearance ranging from a cystic (2.5 x 2.0 x 1.8cm) to deep-red, beefy with pale-tan white, fleshy areas. It appeared to be confined to the capsule without involvement of the outer surface." @default.
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• W2920830952 date "2018-10-01" @default.
• W2920830952 modified "2023-10-16" @default.
• W2920830952 title "Love It or GIST It: Looking Beyond the GIST" @default.
• W2920830952 doi "https://doi.org/10.14309/00000434-201810001-02166" @default.
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