Endoscopic ultrasound-guided histological diagnosis of a mucinous non-neoplastic pancreatic cyst using a specially designed through-the-needle microforceps.

Solitary uniloculated pancreatic cysts pose a major diagnostic dilemma. Cystic fluid carcinoembryonic antigen (CEA) concentration and cytology have low sensitivity in distinguishing mucinous from non-mucinous cysts [1], leading to frequent misdiagnoses and unnecessary surgical interventions [2]. Recently evaluated molecular markers seem very accurate, but they are not widely available in clinical practice [3]. Wepresent the case of a 49-year-oldwomanwhowas incidentallydiscoveredtohave a 25-mm cystic pancreatic neck lesion, without apparent communication with the Wirsung duct (●" Fig.1,●" Video 1). At endoscopic ultrasound (EUS), the cyst had no septa, normal walls, and no mural nodules. Prophylactic intravenous antibiotics were administered and EUS-guided fine-needle aspiration (FNA) was performed using a 19-gauge needle. After 2mL of fluid were aspirated, a toothed microforceps (Moray microforceps; US Endoscopy, Mentor, Ohio, USA) (●" Fig.2), designed specifically for tissue acquisition through a 19-gauge FNA needle, was inserted through the needle into the cyst cavity. Under EUS guidance, the microforceps was opened, pushed against the cyst wall, and then Fig.1 Axial T2 weighted magnetic resonance image showing a 25× 20mm unilocular pancreatic neck cystic lesion without communication with the Wirsung duct (arrow).