Solid pancreatic lesions in young patients (<40 years): Should we be worried about? Lessons from 4 years of EUS guided FNB in a tertiary center

Background: EUS-guided FNB is crucial in the management of solid pancreatic lesions (SPLs). Very little is known about SPLs and the risk of pancreatic cancer (PDAC) in young patients. Methods: All consecutive patients who have undergone EUS-guided FNB for non-metastatic SPLs between July 1st 2021 and June 30th 2025 at the Gastroenterology Unit of the University of Verona were evaluated retrospectively. Demographical, clinical, radiological and endoscopic data were extrapolated from a prospectively maintained database. Results: Among the 1250 included patients, 65 (5.2%) were younger than 40 years. The proportion of PDAC was 12.3% compared with 55.9% of patients older than 40 (p &lt; 0.001). The most frequent SPLs were NET (44.6%) and solid pseudopapillary neoplasms (24.6%). Hypovascular pattern, dilation of the main pancreatic duct (MPD), and of the common bile duct (CBD) were associated with a significant increase of PDAC likelihood in both, general population and patients younger than 40 years. Finally, in 39 patients (60%) the SPLs required surgical resection and in 8 patients (12.3%) the SPLs were benign. Discussion: The proportion of SPLs in patients younger than 40 is remarkable in a tertiary center. Despite the probability of malignancy is lower in this setting, ruling out PDAC is crucial, particularly in case of hypovascular lesions with dilation of MPD and/or CBD.