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A 63-year-old insulin-dependent diabetic womanpresented to ourmultidisciplinary group for evaluation and management of multifocal cystic lesions of the pancreas found incidentally by computed tomography during an evaluation of diverticulitis. Initial assessment included endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) by curved linear array echoendoscope. Near-total replacement of the pancreatic parenchyma by innumerable cysts of various size and character was demonstrated, involving all regions of the pancreas (●" Fig.1;●" Video1). Several cysts exhibited features that gave cause for concern, including size well over 30mm, thickenedwalls, and thickened septations, as well as round, mobile solid structures suggestive of mucin balls (●" Fig.2a). Moreover, the main pancreatic duct appeared to communicate with the cysts in the regions of the head and neck (●" Video1). The minimally spared parenchyma was heterogeneous without lobularity. The major vessels of the abdomen were unremarkable and without abnormality, nor was there evidence of other regional disease or lymphadenopathy. FNAwas performed to recover fluid contents from a larger cystic component, and a second pass was performed to confirm the mobility and benign nature of a suspectedmucin ball (●" Fig.2b).

Diffuse replacement of pancreatic parenchyma by intraductal papillary mucinous neoplasm