ИСТИНА

The presenter is Buntseva O. Introduction and objectives: The differential diagnosis of pancreatic lesions is still a challenging task. Needle-based confocal laser endomicroscopy ( nCLE) can improve the diagnostic yield of endoscopic ultrasonography (EUS) with fine needle aspiration (FNA) for pancreatic lesions. Aim: to show the role of nCLE in diagnosis the pancreatic lesion. Patients / Materials and methods: Methods: Computer tomog raphy (CT), EUS, EUS-FNA, nCLE, cytology, histology. The results: a 66 year old woman was admitted to our hospital for EUS with differential diagnosis between pseudotumours pancreatitis and pancreatic tumour at transabdominal ultrasound and contra st CT. Radial EUS showed the large tumour in the pancreatic body and tail area adjacent to the muscle layer of the gastric wall. Splenic vessels were pushed aside by the lesion and it was difficult to determine the pancreatic parenchyma, which was partly o bserved in the tail. The tumour was 7 cm in longitudinal dimension, inhomogeneous with two different components: in the body, it was a heterogeneous lesion with high echogenicity combined with low echogenicity in general; in the tail the lesion was almost hypoechoic. There were some cystic changes in the distal body. The main pancreatic duct was observed only in the head, 4 mm in diameter with some hyperechoic elements in it without acoustic shadows (precipitates?). EUS data were suspicious for pancreatic tumour, retroperitoneal tumour or lymphoproliferative disease. For precise diagnosis nCLE with EUS-FNA was performed. Inside the tumor nCLE showed the normal pancreatic gland tissue as an oval dark structures similar to coffee beans and clusters of small dark cells suspicious for a cancer, abnormally wide vessels were also seen. In another part of the tumour nCLE revealed the bright, finger like elongated and branching structures, which were different in size and arrangement. In these structures cell's pola rity was destroyed in some area, with dark and different in shape and size nuclei. So, due to nCLE we diagnosed the pancreatic tumour suspicious for malignant intraductal papillary mucinous neoplasm (IPMN). The results of cytological and histological exam ination confirmed pancreatic papillary tumour with severe dysplasia, which could correspond to IPMN associated with carcinoma. The surgery treatment was not performed due to multiple liver metastases, the patient received chemotherapy. Conclusion: EUS-FNA in combination with nCLE can be very informative, useful method for differential diagnosis of pancreatic lesions.