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Gastroenterology (Expert Forum)
Pancreatic cyst -how to get a more definitive diagnosis
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Pancreatic cyst -how to get a more definitive diagnosis
by Byrde, Aug 09, 2003 12:00AM
I am a 48 yr. old white fem. in good health til recently, starting about 5 mos. ago with an intestinal “bug”. I had 2-3 days of diarrhea, 4 or 5 days of nausea & stools a little lighter colored for about 2 wks. Then broke out with red itchy spots on face & mouth/canker sores. I’ve had severe weight loss (25% of body weight)& fatigue problems, but no oily stools & no diarrhea since that initial time, except one incident on the 7th day of taking Diflucan (about 3 mos. ago & I stopped it immed.). After many baffled Drs. & many tests one thing they found was a cystic lesion on my pancreas both on a CT scan and an MRCP. The Spiral CT scan was performed with contrast originally looking for an abdominal/kidney problem.
The CT report reads, “Within the head of the pancreas, there is a large cystic structure measuring 2.4 cm. AP x 2.4 cm. transverse which appears to abut the extrahepatic common bile duct. I question whether this is a choledochal cyst or a large pancreatic pseudocyst. Cystic pancreatic neoplasm considered less likely. No bulky para-aortic, mesenteric or retrocrural adenopathy is seen. No bulky pelvic adenopathy is seen.”
The MRCP report reads, “The gallbladder fluid filled. Within the head of the pancreas there is a well defined cystic lesion measuring 2.5 x 2.2 x 2.9 cm. Otherwise the pancreas is normal in signal. No distinct peripancreatic fluid is identified. This is just medial to the fundus of the gallbladder. The CBG is seen to be distinct and appears to be normal in caliber as does the pancreatic duct. On one of the images it appears that this connects to the gallbladder….There is no evidence for pericholecystic fluid. IMPRESSION: …This lesion may be related most likely to a pancreatic pseudocyst although other possible etiologies may be related to choledochal cyst or a diverticulum of the gallbladder. Followup with an ERCP is recommended.”
Questions:
Could an EUS (without FNA) be able to give a more accurate picture and diagnosis as to whether this is a pseudocyst, neoplasm, etc.? It seems like a less risky, less invasive test than the ERCP. I am feeling better right now, though not yet "normal". I 've never been jaundice or felt pain & my only symptoms have been weight loss (which has stabilized), fatigue (getting much better), red facial spots (now cleared up) and mouth/canker sores (almost all gone). No doctor seems certain this cyst is even related to my other problems. Do you have any other answers or suggestions for my situation? Do you know of any Drs. in the Eastern US that are well skilled in EUS particularly in pancreatic cyst diagnosis?
Thank you so much for your time & consideration!
P.S.—The Diflucan helped my sores clear up & improved my fatigue, until I had the adverse reaction on the 7th day of it. The other thing that seems to have helped is Acidophilus & a sugar free/starch free diet to discourage yeast overgrowth, but don't know if this is contibuting to my lack of weight gain.
The CT report reads, “Within the head of the pancreas, there is a large cystic structure measuring 2.4 cm. AP x 2.4 cm. transverse which appears to abut the extrahepatic common bile duct. I question whether this is a choledochal cyst or a large pancreatic pseudocyst. Cystic pancreatic neoplasm considered less likely. No bulky para-aortic, mesenteric or retrocrural adenopathy is seen. No bulky pelvic adenopathy is seen.”
The MRCP report reads, “The gallbladder fluid filled. Within the head of the pancreas there is a well defined cystic lesion measuring 2.5 x 2.2 x 2.9 cm. Otherwise the pancreas is normal in signal. No distinct peripancreatic fluid is identified. This is just medial to the fundus of the gallbladder. The CBG is seen to be distinct and appears to be normal in caliber as does the pancreatic duct. On one of the images it appears that this connects to the gallbladder….There is no evidence for pericholecystic fluid. IMPRESSION: …This lesion may be related most likely to a pancreatic pseudocyst although other possible etiologies may be related to choledochal cyst or a diverticulum of the gallbladder. Followup with an ERCP is recommended.”
Questions:
Could an EUS (without FNA) be able to give a more accurate picture and diagnosis as to whether this is a pseudocyst, neoplasm, etc.? It seems like a less risky, less invasive test than the ERCP. I am feeling better right now, though not yet "normal". I 've never been jaundice or felt pain & my only symptoms have been weight loss (which has stabilized), fatigue (getting much better), red facial spots (now cleared up) and mouth/canker sores (almost all gone). No doctor seems certain this cyst is even related to my other problems. Do you have any other answers or suggestions for my situation? Do you know of any Drs. in the Eastern US that are well skilled in EUS particularly in pancreatic cyst diagnosis?
Thank you so much for your time & consideration!
P.S.—The Diflucan helped my sores clear up & improved my fatigue, until I had the adverse reaction on the 7th day of it. The other thing that seems to have helped is Acidophilus & a sugar free/starch free diet to discourage yeast overgrowth, but don't know if this is contibuting to my lack of weight gain.
Doctor's Answer
by Kevin Pho, MD, Aug 11, 2003 12:00AM
, Aug 11, 2003 12:00AM
EUS with a FNA is a possibility, however in the cases of pancreatic cysts, there is a moderate chance for a false negative and the accuracy is still being determined in studies.
Other diagnostic options include evaluate of the cyst fluid with tumor markers (eg, CEA, CA 19-9, and many others).
Unfortunately, the definitive diagnostic test to differentiate cysts is difficult. Each modality has its limitations. Another option would be a core biopsy or percutaneous FNA to get a better idea of the characteristics of the fluid.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Other diagnostic options include evaluate of the cyst fluid with tumor markers (eg, CEA, CA 19-9, and many others).
Unfortunately, the definitive diagnostic test to differentiate cysts is difficult. Each modality has its limitations. Another option would be a core biopsy or percutaneous FNA to get a better idea of the characteristics of the fluid.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
