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The limitations of endoscopic ultrasound-guided fine needle aspiration cytology in the diagnosis of pancreatic serous cystadenoma: a brief case report.

Park HS, Yoon SO, Lim BJ, Kim JH, Hong SW - Korean J Pathol (2014)

View Article: PubMed Central - PubMed

Affiliation: Departments of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

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Endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsy is commonly used in the diagnosis of pancreatic tumors... Here, we report a case of pancreatic SCA that was suspected to be adenocarcinoma in preoperative test using EUS-guided FNA... The apical cytoplasm contained neutral mucin that was positive with periodic acid-Schiff (Fig. 2E) and negative with mucicarmine (Fig. 2F) stain... Singly occurring abnormal cells were not found... Pancreatic cystic neoplasms include SCA, mucinous cystic neoplasm (MCN), intraductal papillary mucinous neoplasm (IPMN), solid pseudopapillary tumor, cystic neuroendocrine tumor, and ductal adenocarcinoma with cystic change... The diagnostic value of FNA in SCA is controversial... Earlier studies only consider single case reports or discuss only a few cases, resulting in variable diagnostic accuracy (from 10% to 100%)... The low sensitivity of EUS-guided FNA in the diagnosis of SCA can be attributed to several reasons... Gastric mucosal sampling was also identified in ThinPrep and cell block preparations of this case... Some gastric foveolar cells showed atypical features such as nuclear overlapping and nuclear membrane irregularity, which resulted in the initial misdiagnosis of pancreatic adenocarcinoma... Unequivocal, preoperative diagnosis of SCA using EUS FNA is quite challenging... Neoplastic cells of SCA are usually aspirated in small numbers during the procedure and have benign cytomorphology... Possible gastrointestinal contamination in EUS-guided FNA samples from the pancreas should be considered to prevent the misinterpretation that normal gastric or intestinal epithelial cells are atypical cells, which may result in a misdiagnosis... Familiarity with the cytological features of both SCA and normal gastrointestinal epithelium may help improve the diagnostic accuracy of SCA using EUS-guided FNA samples.

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Cytohistologic findings. Some neoplastic cells are identified in a retrospective review. (A) In the smear preparation, small collections of benign cuboidal epithelial cells are found. (B) In a ThinPrep slide, several loose clusters of cuboidal cells with small, round nuclei are present. Sheets of atypical cells with occasional nuclear overlapping and nuclear grooves are also present in a ThinPrep slide (C), which is proven to be degenerated gastric mucosa epithelium. Gastric mucosal sampling is observed in both the ThinPrep and cell block preparations. (D) The gastric surface epithelium is arranged in a sheet-like structure composed of tall columnar cells with distinct cytoplasmic borders. The apical cytoplasm contains neutral mucin as confirmed by periodic acid–Schiff (E) and mucicarmine (F) staining of the cell block preparation. On histological examination, the cystic mass consists of numerous small cysts lined with a single layer of cuboidal cells with clear cytoplasm (G).
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f2-kjpathol-48-5-405: Cytohistologic findings. Some neoplastic cells are identified in a retrospective review. (A) In the smear preparation, small collections of benign cuboidal epithelial cells are found. (B) In a ThinPrep slide, several loose clusters of cuboidal cells with small, round nuclei are present. Sheets of atypical cells with occasional nuclear overlapping and nuclear grooves are also present in a ThinPrep slide (C), which is proven to be degenerated gastric mucosa epithelium. Gastric mucosal sampling is observed in both the ThinPrep and cell block preparations. (D) The gastric surface epithelium is arranged in a sheet-like structure composed of tall columnar cells with distinct cytoplasmic borders. The apical cytoplasm contains neutral mucin as confirmed by periodic acid–Schiff (E) and mucicarmine (F) staining of the cell block preparation. On histological examination, the cystic mass consists of numerous small cysts lined with a single layer of cuboidal cells with clear cytoplasm (G).

Mentions: The aspiration smear revealed low cellularity with a clean background devoid of mucin. A few small collections of cuboidal epithelial cells with uniform round nuclei and pale cytoplasm were observed (Fig. 2A). The nuclear membranes were smooth, the chromatin was finely granular, and the nucleoli were small. The nuclear-cytoplasmic ratio was low. In a liquid-based preparation, two different cell populations were identified. The first population was composed of loose cell clusters of cuboidal cells with small, round nuclei and undefined cell borders (Fig. 2B). Sheets of atypical cells with disorderly arranged nuclei, occasional nuclear overlapping and nuclear grooves comprised the second cell population (Fig 2C). The cell borders were relatively well defined. These atypical cells were regarded as low-grade adenocarcinoma cells during the initial cytological diagnosis, but they were identified as gastric epithelial cells with degenerating atypia during retrospective review. Epithelial sheets with uniform chromatin and nucleoli, an adequate amount of cytoplasm, and prominent cytoplasmic borders enable us to determine the benign feature of these cells. In addition, those cells had transitional morphologic features from normal gastric surface epithelium observed in both the ThinPrep and cell block preparations (Fig. 2D). The gastric foveolar epithelium was arranged in a sheet-like structure composed of tall columnar cells with distinct cytoplasmic borders. The apical cytoplasm contained neutral mucin that was positive with periodic acid-Schiff (Fig. 2E) and negative with mucicarmine (Fig. 2F) stain. Singly occurring abnormal cells were not found.


The limitations of endoscopic ultrasound-guided fine needle aspiration cytology in the diagnosis of pancreatic serous cystadenoma: a brief case report.

Park HS, Yoon SO, Lim BJ, Kim JH, Hong SW - Korean J Pathol (2014)

Cytohistologic findings. Some neoplastic cells are identified in a retrospective review. (A) In the smear preparation, small collections of benign cuboidal epithelial cells are found. (B) In a ThinPrep slide, several loose clusters of cuboidal cells with small, round nuclei are present. Sheets of atypical cells with occasional nuclear overlapping and nuclear grooves are also present in a ThinPrep slide (C), which is proven to be degenerated gastric mucosa epithelium. Gastric mucosal sampling is observed in both the ThinPrep and cell block preparations. (D) The gastric surface epithelium is arranged in a sheet-like structure composed of tall columnar cells with distinct cytoplasmic borders. The apical cytoplasm contains neutral mucin as confirmed by periodic acid–Schiff (E) and mucicarmine (F) staining of the cell block preparation. On histological examination, the cystic mass consists of numerous small cysts lined with a single layer of cuboidal cells with clear cytoplasm (G).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215972&req=5

f2-kjpathol-48-5-405: Cytohistologic findings. Some neoplastic cells are identified in a retrospective review. (A) In the smear preparation, small collections of benign cuboidal epithelial cells are found. (B) In a ThinPrep slide, several loose clusters of cuboidal cells with small, round nuclei are present. Sheets of atypical cells with occasional nuclear overlapping and nuclear grooves are also present in a ThinPrep slide (C), which is proven to be degenerated gastric mucosa epithelium. Gastric mucosal sampling is observed in both the ThinPrep and cell block preparations. (D) The gastric surface epithelium is arranged in a sheet-like structure composed of tall columnar cells with distinct cytoplasmic borders. The apical cytoplasm contains neutral mucin as confirmed by periodic acid–Schiff (E) and mucicarmine (F) staining of the cell block preparation. On histological examination, the cystic mass consists of numerous small cysts lined with a single layer of cuboidal cells with clear cytoplasm (G).
Mentions: The aspiration smear revealed low cellularity with a clean background devoid of mucin. A few small collections of cuboidal epithelial cells with uniform round nuclei and pale cytoplasm were observed (Fig. 2A). The nuclear membranes were smooth, the chromatin was finely granular, and the nucleoli were small. The nuclear-cytoplasmic ratio was low. In a liquid-based preparation, two different cell populations were identified. The first population was composed of loose cell clusters of cuboidal cells with small, round nuclei and undefined cell borders (Fig. 2B). Sheets of atypical cells with disorderly arranged nuclei, occasional nuclear overlapping and nuclear grooves comprised the second cell population (Fig 2C). The cell borders were relatively well defined. These atypical cells were regarded as low-grade adenocarcinoma cells during the initial cytological diagnosis, but they were identified as gastric epithelial cells with degenerating atypia during retrospective review. Epithelial sheets with uniform chromatin and nucleoli, an adequate amount of cytoplasm, and prominent cytoplasmic borders enable us to determine the benign feature of these cells. In addition, those cells had transitional morphologic features from normal gastric surface epithelium observed in both the ThinPrep and cell block preparations (Fig. 2D). The gastric foveolar epithelium was arranged in a sheet-like structure composed of tall columnar cells with distinct cytoplasmic borders. The apical cytoplasm contained neutral mucin that was positive with periodic acid-Schiff (Fig. 2E) and negative with mucicarmine (Fig. 2F) stain. Singly occurring abnormal cells were not found.

View Article: PubMed Central - PubMed

Affiliation: Departments of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsy is commonly used in the diagnosis of pancreatic tumors... Here, we report a case of pancreatic SCA that was suspected to be adenocarcinoma in preoperative test using EUS-guided FNA... The apical cytoplasm contained neutral mucin that was positive with periodic acid-Schiff (Fig. 2E) and negative with mucicarmine (Fig. 2F) stain... Singly occurring abnormal cells were not found... Pancreatic cystic neoplasms include SCA, mucinous cystic neoplasm (MCN), intraductal papillary mucinous neoplasm (IPMN), solid pseudopapillary tumor, cystic neuroendocrine tumor, and ductal adenocarcinoma with cystic change... The diagnostic value of FNA in SCA is controversial... Earlier studies only consider single case reports or discuss only a few cases, resulting in variable diagnostic accuracy (from 10% to 100%)... The low sensitivity of EUS-guided FNA in the diagnosis of SCA can be attributed to several reasons... Gastric mucosal sampling was also identified in ThinPrep and cell block preparations of this case... Some gastric foveolar cells showed atypical features such as nuclear overlapping and nuclear membrane irregularity, which resulted in the initial misdiagnosis of pancreatic adenocarcinoma... Unequivocal, preoperative diagnosis of SCA using EUS FNA is quite challenging... Neoplastic cells of SCA are usually aspirated in small numbers during the procedure and have benign cytomorphology... Possible gastrointestinal contamination in EUS-guided FNA samples from the pancreas should be considered to prevent the misinterpretation that normal gastric or intestinal epithelial cells are atypical cells, which may result in a misdiagnosis... Familiarity with the cytological features of both SCA and normal gastrointestinal epithelium may help improve the diagnostic accuracy of SCA using EUS-guided FNA samples.

No MeSH data available.


Related in: MedlinePlus