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Milky way

 Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY 11373, USA

Date of Submission08-Feb-2021
Date of Acceptance29-Nov-2021
Date of Web Publication16-Apr-2022

Correspondence Address:
Nirali Sheth,
Department of Internal Medicine, Icahn School of Medicine Mount Sinai, Elmhurst Hospital, 79-01 Broadway, Elmhurst, NY 11373
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-21-00047

PMID: 35435338

How to cite this URL:
Ahmed M, Sheth N, Bansal R, Gurram KC, Aron J. Milky way. Endosc Ultrasound [Epub ahead of print] [cited 2022 May 22]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=343359

Pancreatic cystic lymphangiomas (PCLs) are rare, benign neoplasms classically diagnosed on post-surgical histopathological examination. We describe a rare case of diagnosis and drainage of a PCL using EUS-FNA.[1]

A 60-year-old male with a past medical history of follicular thyroid cancer s/p thyroidectomy was referred for an evaluation of a subepithelial lesion in the posterior wall of the greater curve of the stomach. A computed tomography scan showed a 2.5 cm × 1.8 cm cystic lesion arising from the pancreatic head [Figure 1]. Upon EUS examination, the lesion appeared to be loculated, well marginated, with anechoic contents and thin internal septae. It measured 32.9 mm × 24.7 mm in maximal cross-sectional diameter, arising from the uncinate process of the pancreas [Figure 2]. It did not appear to communicate with the pancreatic duct. There was no associated mass, internal debris, or perilesional lymphadenopathy. No vascularity was evident in the cystic lesion on color doppler examination. A fine-needle aspiration using a 22-gauge needle yielded opaque-milky white fluid [Figure 3]. Biochemical cyst fluid analysis revealed a markedly elevated Triglyceride level of 5980 mg/dL, normal amylase of 105 U/L, and normal carcinoembryonic antigen. Normal serum triglyceride level of 139 mg/dL. This was consistent with a diagnosis of chylous PCL.
Figure 1: Computed tomography of abdomen and pelvis revealed 2.5 cm × 1.8 cm cystic mass arising from the pancreatic head (arrow)

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Figure 2: EUS image of a 32.9 mm × 24.7 mm anechoic, well-loculated lesion arising from the uncinate process of the pancreas

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Figure 3: Milky opaque fluid aspirated from pancreatic cyst

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Carvalho D, Costa M, Russo P, et al. Cystic pancreatic lymphangioma-diagnostic role of endoscopic ultrasound. GE Port J Gastroenterol 2016;23:254-8. doi:10.1016/j.jpge.2016.01.006.  Back to cited text no. 1


  [Figure 1], [Figure 2], [Figure 3]


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