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Fig. 1 A micro-forceps is passed through a 19-gauge needle under endoscopic ultrasound guidance to sample the cystic wall (a). The sample consists of multiple specimens of hypercellular stroma lined by a monolayer epithelium (b). At higher magnification, the mucinous epithelium differentiation is appreciable (c). Alcian-PAS reaction positivity for mucine heavily depicts epithelial cells (d). On immunohistochemistry, the diffuse positivity of stromal cells for Estrogen receptors is consistent with the ovarian-like differentiation (e). On surgical histology, the inner surface of the fibrous wall of the cyst is covered by a mucinous epithelium and ovarian-like stroma is consistent with mucinous cystic neoplasia, low-grade atypia (f) thereby reducing unnecessary resections and costly long-term high-resolution imaging follow-up [3].