Do hyper and hypoechoic foci develop into malignancy?

Question

Hi doctor,

I have a long-standing diagnosis of GERD. Five months back, an upper endoscopy rendered a diagnosis of gastritis, which had occurred several times over the years. Since then, I have taken medicines like Omeprazole, Carafate, Metoprolol, Tamsulosin, and Pepcid. I was taking a capsule Nexium. These have helped to a limited degree. But now, there is also moderate pain in the pancreas (apparently), especially after eating. The pain is usually in the back (right side, under the rib cage), but sometimes it is in front under the right rib cage. Occasionally, the pain is in the side, under the rib cage. And, at times, it is in the center of the back. This occurs almost immediately after eating. Other symptoms are daily upset stomach, bloating, frequent gas, frequent bowel movements, occasional nausea, and night sweats. A recent x-ray suggested some constipation, and a recent EUS suggested hyper and hypoechoic foci in the pancreas. Some EUS images are appended here. I am very concerned about malignancy or something that might develop into a malignancy. My symptoms persist daily. Are these symptoms related to the images? Is there a suggestion for pancreatitis? Is there evidence of a cyst or something else? Please help.

Answer 1

Hi,

Welcome to icliniq.com

I have reviewed your record (reports removed to protect the patient's identity). You have two issues.

1) Gastritis and esophagitis for which you are taking proper medicines can continue the same.

2) Pancreatic lesions.

We need further evaluation so we can have a proper plan for management. So can you please get the following test?

1) Serum creatinine.

2) CA 19-9 blood test.

3) Fecal elastase test.

4) CT (computed tomography) scan abdomen with contrast (Pancreatic protocol).

Regards

Answer 2

Hi,

Welcome back to icliniq.com.

Your creatinine levels are normal. So, yes, there is a possibility these lesions are contributing to your symptoms, but these advised tests will clear the picture more, whether it is due to the pancreas or it is only due to your stomach. I would like to follow you after the reports so I can further guide you.

Regards.

Answer 3

Hi,

Welcome back to icliniq.com.

With regard to your question, Your attached endoscopic ultrasound is suggestive of hypoechoic and hyperechoic lesions. They should have taken FNAC (fine needle aspiration cytology); I do not know why they did not do anything and said you do not worry. Most commonly, pseudocyst formation occurs after an episode of acute pancreatitis, and in most cases, pseudocyst appears as a single cyst. In your case, there is more than one. We need better imaging like CT (computed tomography) scan and blood tests like CA19-9 to look for the nature and size of cysts for further evaluation. Then we will be able to decide what to do next? Regards.

Answer 4

Hi,

Welcome back to icliniq.com.

Yes, these lesions are cysts, and we have to figure out the nature of these cysts so you can get the best treatment at the earliest. Sooner is better.

Regards.