Mucinous cystadenocarcinoma of the pancreas: diagnosis by fine-needle aspiration cytology

My approach to pancreatic fine needle aspiration

Pancreatic fine needle aspiration cytopathology has earned a reputation as a rapid, safe, accurate and cost-beneficial modality of investigation of pancreatic mass lesion. Optimal results can be expected only if these procedures are undertaken regularly in gastroenterology departments processing large numbers of patients; occasional aspirators cannot exploit the technique to full potential. Professional teams following a dedicated approach to patient selection and management develop requisite expertise over time. Cytodiagnosis rests as much on morphological examination as on the milieu in which is it practised, and as much on sample quality as on cellular criteria. This article focuses attention on specimen handling, with particular reference to rapid on-site evaluation. The significance of particular cytodiagnoses in patient care is evaluated, and tumour types that may be encountered are enumerated and illustrated.

Mucinous cystic tumor of the pancreas: an analysis of FNA characteristics with an emphasis on the spectrum of malignancy associated features

Previously, pancreatic mucinous cystic tumors were classified as either benign (cystadenoma) or malignant (cystadenocarcinoma). Descriptions of the fine-needle aspiration (FNA) findings of these neoplasms have heretofore emphasized malignant cytologic characteristics. In the following, we present a summary of a study of FNA characteristics from ten patients with cystic mucinous neoplasms, four of whom have correlating histologic material. In this study, we found a spectrum of cytologic features ranging from completely benign appearing to obviously malignant. We discuss cystic mucinous pancreatic tumors and the associated FNA findings helpful in diagnosis and categorization of these neoplasms. Also, we suggest the inclusion of a new entity in the mucinous neoplasm category.

Cytologic examination of pancreatic juice for differential diagnosis of benign and malignant mucin-producing tumors of the pancreas

BACKGROUND

A new clinical type of pancreatic tumor, the mucin-producing tumor, has been recognized recently. However, it is not always easy to distinguish benign from malignant tumors preoperatively. In this study, three different methods of differentiating mucin-producing tumors of the pancreas were compared.

METHODS

Endoscopic ultrasonography, endoscopic retrograde pancreatography, and cytologic examination of pancreatic juice were performed in 14 patients who had mucin-producing pancreatic tumors (11 carcinomas and 3 adenomas). Pancreatic juice was collected endoscopically without papillotomy.

RESULTS

The sensitivity, specificity, and overall accuracy of endoscopic ultrasonography were 82%, 90%, and 79%, respectively; those of endoscopic retrograde pancreatography were 91%, 91%, and 86%; and those of cytologic examination were 91%, 100%, and 93%.

CONCLUSION

Cytologic examination of pancreatic juice was the best of these three methods for differentiating benign from malignant mucin-producing pancreatic tumors.

Aspiration cytodiagnosis of mucinous cystadenocarcinoma of the pancreas

A case of mucinous cystadenocarcinoma of the pancreas is described in which the cytodiagnosis was made from aspirated material which was obtained under computed tomography (CT) guidance. The case presented further supports the view that aspiration cytodiagnosis of mucinous cystadenocarcinoma (an uncommon pancreatic tumor) can be made with confidence when performed with imaging assistance.

Computed tomography and fine-needle aspiration cytology for preoperative evaluation of cystic tumours of the pancreas

Cystic neoplasms of the pancreas are rare. They may present as a mucinous (malignant or potentially malignant) tumour or as benign serous cystadenoma. Accurate preoperative diagnosis is therefore essential, as an asymptomatic serous tumour may safely be followed clinically for years, whereas mucinous tumours require aggressive surgery. Thirteen patients with cystadenoma and cystadenocarcinoma of the pancreas were reviewed and how best to improve the rate of preoperative diagnosis was considered. Fine-needle aspiration cytology and computed tomography enable accurate preoperative distinction between mucinous and serous cystic tumours of the pancreas.

Needle aspiration cytology, immunocytochemistry, and electron microscopic study of unusual pancreatic carcinoma with pleomorphic giant cells

Needle aspiration cytology, immunocytochemistry, and electron-microscopic findings are presented in three cases of an unusual pancreatic carcinoma in which pleomorphic giant cells formed an integral part of the tumour. All three patients were elderly males (age range 66-83 years) and had pancreatic masses. Notable cytologic features in all cases were the presence of bizarre mononucleated and multinucleated, poorly cohesive tumour giant cells, rare spindle cells, with occasional cannibalism and cytophagocytosis. Immunocytochemical study of aspirated material showed diffuse staining of cytokeratin and EMA within the tumour cells, while B 72.3 was seen as focal trace stain. Electron microscopy of aspirated material demonstrated epithelial features and these were characterised by the presence of tonofilaments and surface microvilli. Based on our findings, it is felt that the bizarre giant cells in this unusual variant of pancreatic carcinoma are of epithelial origin. The differential diagnosis of other tumours that may be associated with predominant giant cells in pancreatic aspirates is appropriately discussed.