1
|
Cao T, Krishna SG. Crystals Identified by Endoscopic Ultrasound-Guided Needle-Based Confocal Laser Endomicroscopy in a Pancreatic Pseudocyst. ACG Case Rep J 2024; 11:e01279. [PMID: 38384320 PMCID: PMC10881083 DOI: 10.14309/crj.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Affiliation(s)
- Troy Cao
- College of Medicine, Ohio State University, Columbus, OH
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH
| |
Collapse
|
2
|
Pancreatic Incidentaloma. J Clin Med 2022; 11:jcm11164648. [PMID: 36012893 PMCID: PMC9409921 DOI: 10.3390/jcm11164648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic incidentalomas (PIs) represent a clinical entity increasingly recognized due to advances in and easier access to imaging techniques. By definition, PIs should be detected during abdominal imaging performed for indications other than a pancreatic disease. They range from small cysts to invasive cancer. The incidental diagnosis of pancreatic cancer can contribute to early diagnosis and treatment. On the other hand, inadequate management of PIs may result in overtreatment and unneeded morbidity. Therefore, there is a strong need to evaluate the nature and clinical features of individual PIs. In this review, we summarize the major characteristics related to PIs and present suggestions for their management.
Collapse
|
3
|
Cruz MAA, Moutinho-Ribeiro P, Costa-Moreira P, Macedo G. Solid Pseudopapillary Neoplasm of the Pancreas: Unfolding an Intriguing Condition. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2022; 29:151-162. [PMID: 35702168 PMCID: PMC9149554 DOI: 10.1159/000519933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/28/2021] [Indexed: 08/10/2023]
Abstract
Pancreatic cancer is one of the most lethal malignant neoplasms, with a 1-year survival rate after diagnosis of 24%, and a 5-year survival rate of only 9%. While this illustrates the behavior of its main histologic type - ductal adenocarcinoma, there are other histologic subtypes of pancreatic cancer that can harbor excellent prognosis. Solid pseudopapillary neoplasm, described as a rare low-grade malignant neoplasm by the World Health Organization, is the best example of that, having an overall 5-year survival rate of about 97%. Not only the prognosis, but everything about this entity is unique: its histogenesis, epidemiology, presentation, imaging characteristics, cytology features, immunohistochemical profile, and treatment. This explains the urge to improve our understanding about this entity and thus our ability to accurately recognize and manage it. Having this in mind, this article aims to summarize the most relevant topics regarding this entity.
Collapse
Affiliation(s)
| | - Pedro Moutinho-Ribeiro
- Faculty of Medicine, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Pedro Costa-Moreira
- Faculty of Medicine, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, Porto, Portugal
- Gastroenterology Department, Centro Hospitalar e Universitário São João, Porto, Portugal
| |
Collapse
|
4
|
Hirabayashi K, Saika T, Nakamura N. Background features in the cytology of pancreatic neoplasms. DEN OPEN 2022; 2:e105. [PMID: 35873514 PMCID: PMC9302047 DOI: 10.1002/deo2.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 11/05/2022]
Abstract
Cytology is a useful method for diagnosing pancreatic neoplasms. Although endoscopic ultrasound‐guided fine‐needle aspiration has recently become the mainstream method for the diagnosis of pancreatic neoplasms, pancreatic juice and pancreatic duct brushing cytology continue to be useful diagnostic methods for the investigation of pancreatic neoplasms. Diagnoses using pancreatic cytology are primarily based on the features related to tumor cells; however, evaluation of the background features provides important information that could further aid the diagnosis. Pancreatic neoplasms show various histological types, each of which is associated with its own characteristic background features. The necrotic background, desmoplastic stroma, and presence of cancer‐associated fibroblasts are background features of pancreatic ductal adenocarcinoma, a mucinous background is associated with intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, and hyaline globules are observed in solid pseudopapillary neoplasms. However, some background features are associated with more than one histological type of pancreatic neoplasm, highlighting the importance to base a diagnosis on the results of a comprehensive analysis of not only the background features but also the tumor cells. Here, we provide a review of the key background cytological features of pancreatic neoplasms, which can serve as a guide to improve diagnosis and research.
Collapse
Affiliation(s)
| | - Tsubasa Saika
- Diagnostic Pathology Center Tokai University Hospital Kanagawa Japan
| | - Naoya Nakamura
- Department of Pathology Tokai University School of Medicine Kanagawa Japan
| |
Collapse
|
5
|
Cytological Diagnosis of Pancreatic Solid-Pseudopapillary Neoplasm: A Single-Institution Community Practice Experience. Diagnostics (Basel) 2022; 12:diagnostics12020449. [PMID: 35204541 PMCID: PMC8871439 DOI: 10.3390/diagnostics12020449] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction. Pancreatic solid-pseudopapillary neoplasm (SPN) is a rare tumor that typically occurs in young females. Although a cytological diagnosis may be easily made in this age group when there are typical features, atypical clinical presentations and unusual cytological features may make this a challenging diagnosis. We present our single-institution experience in a cohort of these tumors, outlining both typical and atypical features. Awareness of unusual clinical and cytological features can help to avoid pitfalls during diagnosis. Methods. We performed a review of all cases of pancreatic SPNs diagnosed over a 15-year period (January 2007 to December 2021). Detailed cytological, clinical, and follow-up histological features were presented and analyzed. Results. Twenty-two cases of SPN were diagnosed at our institution during this 15-year period. Patients ranged from 12 to 73 years of age (mean 33 y, median 26 y) and included 19 females and 3 males. Seventeen patients had cytological material, and fourteen were diagnosed by EUS-FNA. Typical cytological features included papillary clusters with central capillaries, myxoid stroma, monomorphism, cercariform cells, and hyaline globules. Atypical or unusual cytological features that were seen in a few cases were multinucleated giant cells, clear cells, and/or foamy macrophages. A few cases showed features that were similar to pancreatic neuroendocrine tumors (PanNETs). Tumor cells were always positive for β-catenin, CD10, CD56, cyclin-D1, progesterone receptor (PR), and vimentin by immunohistochemistry. They were always negative for chromogranin. Pancytokeratin and synaptophysin stains were positive in 9% and 46% of cases evaluated, respectively. All cases had histological confirmation on resection. The median follow-up duration was 69 months (a range of 2–177 months), with only three cases lost to follow-up. No recurrence or metastasis was identified. Conclusions. We present our experience with cytological diagnoses of SPN in a well-characterized cohort of 22 patients with histological correlation and follow-up data. These tumors occur over a wide range and show varied cytological features. SPNs can be confidently diagnosed on limited cytological material, with limited panel immunohistochemistry aiding diagnosis in atypical cases. Recognizing the associated degenerative changes is crucial in avoiding a misdiagnosis.
Collapse
|
6
|
Jain PV, Griffin M, Hunt B, Ward E, Tsai S, Doucette S. Undifferentiated carcinoma with osteoclast-like giant cells: A pathologic-radiologic correlation of a rare histologic subtype of pancreatic ductal adenocarcinoma. Ann Diagn Pathol 2022; 57:151884. [DOI: 10.1016/j.anndiagpath.2021.151884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/01/2022]
|
7
|
La Rosa S, Bongiovanni M. Pancreatic Solid Pseudopapillary Neoplasm: Key Pathologic and Genetic Features. Arch Pathol Lab Med 2021; 144:829-837. [PMID: 31958381 DOI: 10.5858/arpa.2019-0473-ra] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2019] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor generally associated with a good prognosis. Solid pseudopapillary neoplasms show peculiar morphologic features, but sometimes the differential diagnosis with other pancreatic neoplasms (ie, pancreatic neuroendocrine tumors) can be a challenging task, especially in cytologic or biopsy specimens. In these cases immunohistochemistry is a useful tool, but the diagnostic utility of several proposed immunohistochemical markers is questionable. In recent years, despite several attempts to characterize the pathogenetic, molecular, and prognostic features of solid pseudopapillary neoplasms, they still remain unclear. OBJECTIVE.— To give the reader a comprehensive update on this entity. DATA SOURCES.— The PubMed database (US National Library of Medicine) was searched using the following string: pseudopapillary tumor [AND/OR] neoplasm [AND/OR] pancreas. All articles written in English were included. In addition, because a heterogeneous terminology has been used in the past to define solid pseudopapillary neoplasms, the reference lists of each paper selected in the PubMed database were also reviewed. CONCLUSIONS.— This review gives a comprehensive update on the pathologic, clinical, and molecular features of solid pseudopapillary neoplasms, particularly addressing issues and challenges related to diagnosis. In addition, we have tried to correlate the molecular alterations with the morphologic and clinical features.
Collapse
Affiliation(s)
- Stefano La Rosa
- From the Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (Dr La Rosa); Synlab Swiss SA, Pathology, Lausanne, Switzerland (Dr Bongiovanni)
| | - Massimo Bongiovanni
- From the Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland (Dr La Rosa); Synlab Swiss SA, Pathology, Lausanne, Switzerland (Dr Bongiovanni)
| |
Collapse
|
8
|
El Hussein S, Colanta A, Khader SN. Revisiting cercariform cells: Small cell carcinoma masquerading as cercariform cells. Diagn Cytopathol 2019; 47:1072-1075. [PMID: 31386301 DOI: 10.1002/dc.24296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/09/2019] [Accepted: 07/23/2019] [Indexed: 11/09/2022]
Abstract
Cercariform cells are slender cells with a bulbous end and a unipolar long cytoplasmic process, resembling Schistosoma cercariae. Since their first description in urothelial carcinoma, multiple studies have attempted to explore their utility in distinguishing metastatic urothelial carcinoma from other common malignant neoplasms, such as adenocarcinoma and squamous-cell carcinoma. Although not pathognomonic, they are most commonly encountered in urothelial carcinoma, but they can also be seen in other neoplasms, raising the possibility that this cytomorphological feature can be exploited to aid in diagnosis.
Collapse
Affiliation(s)
- Siba El Hussein
- The Leopold G. Koss Department of Cytopathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Agnes Colanta
- The Leopold G. Koss Department of Cytopathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Samer N Khader
- The Leopold G. Koss Department of Cytopathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| |
Collapse
|
9
|
Misra S, Saran RK, Srivastava S, Barman S, Dahale A. Utility of cytomorphology in distinguishing solid pseudopapillary neoplasm of pancreas from pancreatic neuroendocrine tumor with emphasis on nuclear folds and nuclear grooves. Diagn Cytopathol 2019; 47:531-540. [DOI: 10.1002/dc.24145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/05/2018] [Accepted: 01/02/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Sunayana Misra
- Department of PathologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| | - RK Saran
- Department of PathologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| | - Siddharth Srivastava
- Department of GastroenterologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| | - Sandip Barman
- Department of PathologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| | - Amol Dahale
- Department of GastroenterologyGB Pant Institute of Post Graduate Medical Education and Research 1 Jawahar Lal Nehru Marg, New Delhi India
| |
Collapse
|
10
|
Policarpio-Nicolas MLC, McHugh KE, Sae-Ow W, Brainard JA. Pleomorphic and atypical multinucleated giant cells in solid pseudopapillary neoplasm of pancreas: A diagnostic pitfall in cytology and a review of the literature. Diagn Cytopathol 2018; 47:488-493. [PMID: 30552752 DOI: 10.1002/dc.24129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/14/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023]
Abstract
Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare low-grade malignancy typically occurring in young women. Occasionally, these neoplasms present with pleomorphic to atypical multinucleated giant tumor cells which may mimic high-grade malignancy. Our patient is a 25-year-old male who presented with one year of intermittent epigastric pain. Magnetic resonance imaging showed a 3.1 × 2.5 cm mass in the pancreas body. Endoscopic ultrasound-guided fine needle aspiration of the mass showed large pleomorphic cells and atypical multinucleated giant cells in a background of singly scattered polygonal cells. Focally, these cells surrounded delicate hyalinized to fibrovascular cores forming pseudopapillae. Immunohistochemical stains show tumor cells are positive for beta-catenin, CD10, vimentin, and CD56. Although rare surgical pathology publications have described the presence of pleomorphic to atypical multinucleated giant cells occurring in SPN, to our knowledge, this is the first case reported example focused on cytomorphologic illustration and description.
Collapse
Affiliation(s)
| | - Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Wichit Sae-Ow
- Department of Pathology, The Queen's Medical Center, Honolulu, Hawaii
| | | |
Collapse
|
11
|
Raddaoui EM, Almadi MA, Aljebreen AM, Alsaif FA, AlShedoukhy AA, Al-Lehibi AH, Almohameed KA, Tsolakis AV, AlAbbadi MA, Almutrafi AR. Differential diagnosis between pancreatic neuroendocrine and solid pseudopapillary neoplasms on endoscopic ultrasound-guided fine-needle aspiration. An immunohistochemical study. Saudi Med J 2017; 37:744-9. [PMID: 27381533 PMCID: PMC5018637 DOI: 10.15537/smj.2016.7.14212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objectives: To evaluate the role of applying a limited panel of immunohistochemical stains on the cellblock preparation from samples obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the aim of differentiating solid pseudopapillary neoplasms (SPNs) from neuroendocrine tumors (NETs). Methods: We retrospectively retrieved all the EUS-FNAs of the pancreas that have a diagnosis of NET or SPN that were performed at 2 tertiary care hospitals in Riyadh, Kingdom of Saudi Arabia from May 2004 to December 2014. Diff-Quik, Papanicolaou, and Immunohistochemistry stains on cellblock preparations were performed. Results: Twenty cases were available (16 pancreatic neuroendocrine tumors (pNETs) and 4 SPNs). The pNETs were immunoreactive for synaptophysin, chromogranin A and CD56 while E-cadherin was diffusely to focally cytoplasmic positive. β-catenin was negative or showed focal cytoplasmic immunoreactivity. In comparison, SPNs were positive for vimentin, CD10, CD-56, focally positive for progesterone receptors and synaptophysin, and revealed nuclear immunostaining for β-catenin. They were negative for chromogranin A and E-cadherin. Conclusion: Based on EUS-FNA samples, nuclear immunoreactivity for β-catenin with loss of membranous immunostaining for E-Cadherin can potentially facilitate differentiating SPNs from pNETs.
Collapse
Affiliation(s)
- Emad M Raddaoui
- Department of Pathology, College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia. E-mail.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Dinarvand P, Lai J. Solid Pseudopapillary Neoplasm of the Pancreas: A Rare Entity With Unique Features. Arch Pathol Lab Med 2017; 141:990-995. [PMID: 28661210 DOI: 10.5858/arpa.2016-0322-rs] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Solid pseudopapillary neoplasm of the pancreas is a rare entity with low malignant potential and excellent overall prognosis. It has nonspecific clinical presentations such as abdominal pain and nausea, with vague radiologic features. Histologic features of this neoplasm are usually specific. The tumor shows minimally cohesive, uniform, monotonous cells lining delicate capillary-sized blood vessels, described as pseudopapillary architecture. Other features including hyaline globules, cytoplasmic vacuoles, and nuclear grooving are frequently present. Use of a select panel of immunostains always helps pathologists to differentiate this tumor from other circumscribed tumors of the pancreas. Recently, β-catenin, CD10, and E-cadherin have been shown to be very important in the diagnosis of solid pseudopapillary neoplasm. Nuclear staining of tumor cells by β-catenin and membranous presentation of CD10 is seen in almost 100% of cases. Tumor cells can be partially positive for synaptophysin and chromogranin. This tumor has a low malignant potential, and definite treatment is surgical resection.
Collapse
Affiliation(s)
| | - Jinping Lai
- From the Department of Pathology, School of Medicine, Saint Louis University, Saint Louis, Missouri
| |
Collapse
|
13
|
Hooper K, Tracht JM, Eldin-Eltoum IA. Cytologic criteria to reduce error in EUS-FNA of solid pseudopapillary neoplasms of the pancreas. J Am Soc Cytopathol 2017; 6:228-235. [PMID: 31043292 DOI: 10.1016/j.jasc.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Standardization of error classification in pathology remains an important issue. This study assesses the extent of error in cytopathologic diagnosis of solid pseudopapillary neoplasms (SPN) of the pancreas. Because of morphologic overlap of SPN and pancreatic neuroendocrine neoplasms (NET), we compared cytologic characteristics to determine which best distinguishes these entities. MATERIALS AND METHODS We collected cases diagnosed as SPN either by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) by cytology or surgical pathology from January 2000 to March 2013. An equal number of NET cases were randomly selected. Cytology and surgical pathology cases were evaluated for diagnostic errors and patient impact. Cytologic features in SPN and NET were scored based on presence of previously described characteristics. RESULTS A total of 17 patients with EUS-FNA were diagnosed with SPN by cytology or surgical pathology. Of those, 14 had surgical follow-up and 13 had adequate cell blocks and immunohistochemistry. There were 5 discrepancies between cytology and surgical pathology (5 of 14, 36%). There were no false positives or false negatives, but 5 misclassifications: 4 diagnosed as NET on cytology, and 1 as NET versus SPN. All misclassification errors were associated with no harm. When compared with NET, fine chromatin, nuclear grooves, pseud papillae, pink stroma, and hyaline globules are statistically significantly associated with SPN. CONCLUSIONS EUS-FNA of pancreatic SPN has excellent positive and negative predictive value, with no false positives or false negatives in this 12-year study. Only misclassification errors as pancreatic NET were made with minimal impact. We suggest that the presence of 3 of 5 major cytologic criteria offer accuracy in diagnosing SPN to prevent misclassification.
Collapse
Affiliation(s)
- Kari Hooper
- Department of Cytopathology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Jessica M Tracht
- Department of Cytopathology, The University of Alabama at Birmingham, Birmingham, Alabama.
| | - Isam A Eldin-Eltoum
- Department of Cytopathology, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
14
|
Reid MD, Muraki T, HooKim K, Memis B, Graham RP, Allende D, Shi J, Schaeffer DF, Singh R, Basturk O, Adsay V. Cytologic features and clinical implications of undifferentiated carcinoma with osteoclastic giant cells of the pancreas: An analysis of 15 cases. Cancer Cytopathol 2017; 125:563-575. [DOI: 10.1002/cncy.21859] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/13/2017] [Accepted: 02/21/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Michelle D. Reid
- Department of Pathology; Emory University Hospital; Atlanta Georgia
| | - Takashi Muraki
- Department of Pathology; Emory University Hospital; Atlanta Georgia
| | - Kim HooKim
- Department of Pathology; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Bahar Memis
- Department of Pathology; Emory University Hospital; Atlanta Georgia
| | | | | | - Jiaqi Shi
- Department of Pathology; University of Michigan; Ann Arbor Michigan
| | - David F. Schaeffer
- Department of Pathology; Vancouver General Hospital; Vancouver British Columbia Canada
| | - Remmi Singh
- Department of Pathology; Northside Hospital; Atlanta Georgia
| | - Olca Basturk
- Department of Pathology; Memorial Sloan-Kettering Cancer Center; New York New York
| | - Volkan Adsay
- Department of Pathology; Emory University Hospital; Atlanta Georgia
| |
Collapse
|
15
|
Raymond SLT, Au K, Fu R, Tauchi-Nishi PS. Metastatic genitourinary cancer diagnosed by body fluid cytology: clinicopathologic and cytomorphologic correlation. J Am Soc Cytopathol 2017; 6:48-58. [PMID: 31042634 DOI: 10.1016/j.jasc.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Malignant effusions secondary to genitourinary cancers constitute less than 5% of metastatic malignancies. Because of their rarity, definitive cytodiagnosis may be challenging. Our study aims to examine the incidence of malignant fluids secondary to genitourinary cancers in our institution, and to characterize their clinicopathologic and cytomorphologic features. METHODS A search of our database was undertaken for all body fluids reviewed from January 2003 through April 2014 at our institution. RESULTS During this 11.3-year study period, our search revealed 8255 body fluids. Of these, 1341 (16.2%) were malignant with only 15 (0.2%) due to a genitourinary primary, constituting a mere 1.1% of all malignant fluids. Eight cases (53%) were urothelial carcinomas, 6 (40%) were renal cell carcinomas, and 1 was a bladder leiomyosarcoma (7%). No prostate cancers were found. Seven (47%) involved the pleura, 6 (40%) were in the peritoneum, and 2 (13%) were in the cerebrospinal fluid (CSF). None were detected in the pericardium. Genitourinary metastases comprised 1.9% of peritoneal, 0.8% of pleural, 1.9% of CSF malignant fluids. CONCLUSION Metastatic genitourinary cancers in body fluids are rare, comprising only 0.2% of all fluids and 1.1% of all malignancies. The cytomorphologic features of metastatic urothelial and renal cell carcinoma, although similar to those described in the literature, are nonspecific. To our knowledge, this is the first reported case of metastatic bladder leiomyosarcoma in ascites diagnosed by effusion cytology. Because leiomyosarcoma in body fluids can demonstrate epithelioid features and cohesiveness, it may be confused with metastatic carcinomas.
Collapse
Affiliation(s)
| | - Kaylene Au
- Department of Pathology, The Queen's Medical Center, Honolulu, Hawaii
| | - Ryan Fu
- Department of Pathology, The Queen's Medical Center, Honolulu, Hawaii
| | - Pamela S Tauchi-Nishi
- Department of Pathology, University of Hawaii, Honolulu, Hawaii; Department of Pathology, The Queen's Medical Center, Honolulu, Hawaii.
| |
Collapse
|
16
|
Machado I, López-Soto MV, Pérez-López AS, Domínguez-Álvarez C, Llombart-Bosch A. Hyaline globules and papillary fragments in cytologic smears from two intra-abdominal tumors (ovarian and hepatic) in female patients: A diagnostic pitfall with histologic correlation. Diagn Cytopathol 2016; 44:935-943. [DOI: 10.1002/dc.23531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/11/2016] [Accepted: 06/24/2016] [Indexed: 12/28/2022]
Affiliation(s)
- Isidro Machado
- Pathology Department; Instituto Valenciano De Oncología; Valencia Spain
| | | | | | | | | |
Collapse
|
17
|
Matsubayashi H, Matsui T, Yabuuchi Y, Imai K, Tanaka M, Kakushima N, Sasaki K, Ono H. Endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of solid pancreaticobiliary lesions: Clinical aspects to improve the diagnosis. World J Gastroenterol 2016; 22:628-640. [PMID: 26811612 PMCID: PMC4716064 DOI: 10.3748/wjg.v22.i2.628] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 09/20/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreaticobiliary lesions since the 1990s and is in widespread use throughout the world today. We used this method to confirm the pathological evidence of the pancreaticobiliary lesions and to perform suitable therapies. Complications of EUS-FNA are quite rare, but some of them are severe. Operators should master conventional EUS observation and experience a minimum of 20-30 cases of supervised EUS-FNA on non-pancreatic and pancreatic lesions before attempting solo EUS-FNA. Studies conducted on pancreaticobiliary EUS-FNA have focused on selection of suitable instruments (e.g., needle selection) and sampling techniques (e.g., fanning method, suction level, with or without a stylet, optimum number of passes). Today, the diagnostic ability of EUS-FNA is still improving; the detection of pancreatic cancer (PC) currently has a sensitivity of 90%-95% and specificity of 95%-100%. In addition to PC, a variety of rare pancreatic tumors can be discriminated by conducting immunohistochemistry on the FNA materials. A flexible, large caliber needle has been used to obtain a large piece of tissue, which can provide sufficient histological information to be helpful in classifying benign pancreatic lesions. EUS-FNA can supply high diagnostic yields even for biliary lesions or peri-pancreaticobiliary lymph nodes. This review focuses on the clinical aspects of EUS-FNA in the pancreaticobiliary field, with the aim of providing information that can enable more accurate and efficient diagnosis.
Collapse
|
18
|
Jahangir S, Loya A, Siddiqui MT, Akhter N, Yusuf MA. Accuracy of diagnosis of solid pseudopapillary tumor of the pancreas on fine needle aspiration: A multi-institution experience of ten cases. Cytojournal 2015; 12:29. [PMID: 26884802 PMCID: PMC4730789 DOI: 10.4103/1742-6413.171140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/19/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction: Solid pseudopapillary tumor of the pancreas (SPTP) is a neoplasm of uncertain origin and indolent biologic behavior with distinctive morphological features occurring predominantly in young women. This tumor has an excellent prognosis compared to neuroendocrine and acinar cell carcinoma, which are close differential diagnoses based on morphology, hence making it crucial to diagnose SPTP correctly. Objectives: To discuss the cytomorphological features of 10 cases of SPTP reported in two institutions and to evaluate the diagnostic accuracy of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) cytology in establishing the diagnosis of SPTP. Methods: Ten diagnosed cases of SPTP were retrieved from the computerized endoscopy and pathology databases of our two tertiary care institutions. Nine patients had subsequent histological follow-up available. Eight patients underwent EUS-FNA while one patient each had ultrasound and computed tomography-guided FNA. The rapid on-site evaluation was carried out in all 10 cases, and additional material was retained for cell block preparation. Immunohistochemical (IHC) stains ranging from synaptophysin, progesterone receptor, chromogranin, β-catenin, CD10, and NSE were applied on cell blocks. Histological sections of all resected specimens were reviewed, and findings were correlated with those obtained by FNA. Results: Adequate material was obtained in all ten cases. IHC stains helped to confirm the cytological impression of SPTP. Histological examination of resection specimens, available in 9/10 cases, confirmed the cytological diagnosis. Conclusions: FNA particularly that obtained with EUS guidance is an effective tool in the accurate diagnosis of SPTP.
Collapse
Affiliation(s)
- Sidra Jahangir
- Address: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asif Loya
- Address: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Noreen Akhter
- Address: Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammed Aasim Yusuf
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| |
Collapse
|