A 47-year-old woman with history of alcohol abuse presented with several months’ history of epigastric pain. CT revealed a cystic lesion in pancreatic head. Endoscopic ultrasound revealed a 32 mm x 23 mm cystic lesion in pancreatic head with solid material in part of the cyst. Because of concern for malignancy, trans-gastric EUS FNA was performed using a 22 gauge needle. A total of 15 ml of watery fluid was removed. Cyst fluid was completely removed and solid material aspirated.
The patient received intravenous antibiotics during the procedure and oral antibiotics for 5 days after. Final cytology revealed benign cells. Cyst fluid amylase was 115 250 units/L and lipase 355 930 units/L. Carcinoembryonic antigen (CEA) level in cyst fluid was 6.6 nanogram/mL. This was felt most consistent with a benign pseudocyst.