Endosonography and Confocal Endomicroscopy of Primary Keratinizing Squamous Cell Carcinoma of the Pancreas

A 79-year-old woman presented with abdominal discomfort and unintentional weight loss. A computed tomography scan demonstrated a 7-cm complex pancreatic cystic lesion (PCL) along with multiple hepatic cystic lesions (Figure 1). Endoscopic ultrasound (EUS) demonstrated a 7.1 cm x 6.7 cm anechoic cystic lesion with an irregularly thick wall and multiple mural nodules in the pancreatic body without obvious communication with the main pancreatic duct (Figure 2). Multiple cysts were also found in the liver, with the largest measuring 25 mm x 20 mm. Given the size and imaging findings of the PCL, a broad differential including mucinous cystic neoplasm, serous cystadenoma, or solid psuedopapillary neoplasms was considered. Less concerning was intrapapillary mucinous neoplasm, as there was no pancreatic duct dilatation or communication with the main pancreatic duct