Eus-guided fiducial markers implantation for precise localization of pancreatic net

A 73-year-old man was referred with weight loss and newly diagnosed diabetes. Abdominal CT and MRI scans showed non-specific enlarged pancreatic body without focal lesions. Conversely, EUS revealed a 21×17mm irregular, well-defined lesion within the pancreatic body, with hypoechoic capsule and intense enhancement after contrast medium injection, suspicious for a NET, in a context of chronic pancreatitis. FNB and histological examination confirmed the diagnosis of NET. To facilitate NET localization during surgery, we performed EUS-guided fiducial marker implantation. Fiducial marker visualization on intraoperative ultrasound scan aided the precise localization of the pancreatic NET, and successful distal splenopancreasectomy was performed.