P-HPB-11: A retrospective analysis of 142 pancreatic masses in a tertiary referral center in west india

OBJECTIVES: To study and characterize pancreatic masses using endoscopic ultrasound (EUS) with fine needle aspiration (FNA) and prove that not all pancreatic masses are malignant and require surgery. METHODS: A total of 142 cases with pancreatic masses were studied with EUS FNA. FNA was done with a 22-gauge needle for lesions in the body and tail and 25-gauge needle from the duodenum. RESULTS: Age 42+/-15.3 Sex Male: Female: 95:47 Location: head-68, body and neck-38, uncinate-26, tail-10. Echo characteristics: hypoechoic-82, hyperechoic-15, mixed solid and cystic-45 (areas of necrosis). Size 4.6+/-3.9 cm. Cytology: ductal adenocarcinoma-77 (54.2%), nonmalignant (inflammatory)-14 (9.9%), neuroendocrine tumors (NETs)-13 (9.1%), tuberculosis-10 (7.1%), solid pseudopapillary tumors (SPTs)-10 (7.1%), walled-off necrosis-11 (7.7%), mucinous adenocarcinoma-03 (2.1%), diagnosis not reached on FNA-04 (2.8%). Complications: Mild pancreatitis in two cases. No infection or major bleed was noted in our series. DISCUSSION: Not all pancreatic tumors are malignant. Inflammatory lesions in chronic pancreatitis are common. Tuberculosis in India should be thought of. NET and SPT are most common in females and majority in body and tail. CONCLUSION: All pancreatic tumors are not ductal adenocarcinomas. A large differential diagnosis is seen in studies. Therefore, it would be worth to sample these lesions before subjecting them to major pancreatoduodenal resections as the management plan or the surgical approach would be altered depending on the cytological diagnosis achieved. EUS FNA is a very good option with minimal risk to give a tissue diagnosis before planning surgery.