PMC4158715_01
Linear-array endoscopic ultrasound (EUS) image of the isoechoic mass lesion in the tail of pancreas, superior to the left kidney.
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F1
Linear-array EUS (GF-UCT 240; Olympus Corp., Center Valley, Pennsylvania, USA) confirmed a tail mass (Fig.1).
Fluoroscopic image showing the linear-array echoendoscope with the 19-gauge fine-needle aspiration (FNA) needle and the first fiducial.
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F2
At EUS, the fiducials were deployed within the tumor by advancing the stylet forward (Fig.2).
Endoscopic ultrasound (EUS) image showing the markers within the lesion casting an acoustic shadow (arrow).
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F3
Overall, two fiducials were deployed (Fig.3), and a preoperative computed tomography (CT) scan confirmed their position.
Intraoperative fluoroscopic image with the stapler gun in place. The two fiducial markers can be easily visualized.
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F4
At laparoscopy, the fiducials were identified using cross-table fluoroscopy (Fig.4), and distal pancreatectomy with splenectomy was performed.
Postoperative specimen of the pancreas, showing the fiducial marker within the lesion.
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F5
A frozen section confirmed negative tumor margins, and the explant specimen revealed the tumor with fiducials in place (Fig.5).
Postoperative histological specimen showing uniform sheets of polyhedral cells with hyperchromatic nuclei and abundant eosinophilic cytoplasm, consistent with a neuroendocrine neoplasm (hematoxylin and eosin stain, x40).
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F6
Final pathological analysis revealed T1 N0 grade II pancreatic neuroendocrine neoplasm (Fig.6).