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Fine‐needle aspiration cytology of intraductal papillary mucinous tumors of the pancreas
Author(s) -
Solé Manel,
Iglesias Carmela,
FernándezEsparrach Glòria,
Colomo Lluis,
Pellisé Maria,
Ginés Àngels
Publication year - 2005
Publication title -
cancer cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.21242
Subject(s) - medicine , mucocele , atypia , pathology , pancreas , mucin , fine needle aspiration , mucinous carcinoma , carcinoma , biopsy , nuclear atypia , radiology , adenocarcinoma , cancer , immunohistochemistry
BACKGROUND Intraductal papillary mucinous tumors (IPMT) account for 5% of pancreatic neoplasms. Preoperative identification is important because of their frequent multifocal or diffuse involvement in pancreatic ducts, which makes extensive surgery necessary even in benign cases. To the authors' knowledge, the cytologic features of this entity in fine‐needle aspiration biopsy (FNAB) specimens have seldom been described and are poorly standardized. METHODS Eleven consecutive cases of surgically proven IPMT with previous endoscopic ultrasonography (EUS)‐guided FNAB were collected for retrospective analysis. EUS‐FNAB had been performed with on‐site attendance of a cytopathologist in all cases. Macroscopic and microscopic appearance of mucin, cellular type and arrangement, presence of nuclear grooves, and degree of nuclear atypia were recorded. RESULTS Final diagnosis was benign IPMT (B) in four cases, borderline IPMT (Bo) in two cases, malignant IPMT (M) in one case, and IPMT associated with invasive carcinoma (Ca) in four. Retrospective analysis found moderate to high levels of extracellular mucin in 10 of the 11 cases. The other case (one Ca) showed a small amount of thick mucin. In all cases, epithelial cells were identified, although cellularity was very low in four cases (three B and one Bo). Atypia was absent in two cases (two B) slight in two cases (two B), moderate in three cases (one Bo and two Ca), and severe in four cases (one Bo, one M, and two Ca). Mucinous epithelium was found in nine cases and nonmucinous epithelium in five cases (one Bo and four Ca). Papillary structures were observed in five cases (two Bo and three Ca), sheets in eight cases (four B, one Bo, one M, and two Ca), single atypical cells in five cases (one Bo and four Ca), irregular clusters in three cases (one Bo and two Ca), and nuclear grooves in two cases (one B and one Bo). CONCLUSIONS The most common features of IPMT were extracellular mucin and sheets of mucinous epithelium. Papillae and nuclear grooves were not consistently found. Nonmucinous epithelium, severe atypia, single atypical cells, and irregular clusters indicated a high probability of malignant transformation. Even in the absence of atypia, a clinically significant diagnostic orientation can be established in most cases on the basis of the characteristic cytologic picture. Cancer (Cancer Cytopathol) 2005. © 2005 American Cancer Society.