RARE RETROPERITONEAL TUMOR DIAGNOSED BY EUS-GUIDED FINE NEEDLE ASPIRATION

Aims:

We present a case of a rare retroperitoneal tumor diagnosed with EUS -guided fine needle aspiration.

Methods:

The report includes description of clinical history as well as imaging, endoscopic and pathology findings.

Results:

A fifty-year old woman presented with abdominal pain in the upper left quadrant. Her medical history revealed diabetes and high blood pressure. During a work up two years earlier, a pancreatic mass was identified. Magnetic resonance imaging (MRI) revealed that the mass was extrapancreatic (18 × 31 mm). An endoscopic ultrasound (EUS) characterized the mass as hypoechogenic and hypervascularized. Fine-needle aspiration (FNA) was not contributory. Serum lipases, liver enzymes, CEA, CA 19 – 9 and chromogranin levels were normal. The presumed diagnosis was that of an accessory spleen. The patient underwent a new MRI in 2017. The mass had increased in size (47 × 44 mm). The PET/CT showed moderate metabolic activity in the mass. The patient is referred to our institution for a complementary work-up. A scintigraphy with nanocolloid radiolabeled with 99mTc was not in favor of an accessory spleen. A second EUS revealed a 50 mm extra-pancreatic mass 5 cm without invasion of the adjacent vascular structures. FNA revealed cytology suggesting hemangioperycitoma (HPC). The patient was addressed for surgical resection.

Conclusions:

HPC is a rare soft tissue sarcoma, mostly described in the central nervous system. It is associate with aggressive prognosis and a tendency to metastasis or recurrence. Exceptional cases of HPC arising outside of the central nervous system including liver, gastrointestinal tract, retroperitoneum, have been reported. No typical CT findings have been reported for HPC. The first choice of treatment for HPC is wide surgical excision. Local recurrence rates up to 90% and metastatic rates up to 33% have been reported. This case underlines the increasing diagnostic possibilities of EUS-FNA, in conjecture with a competent pathologist.