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Serous cystadenoma of the pancreas
Author(s) -
Belsley Nicole A.,
Pitman Martha B.,
Lauwers Gregory Y.,
Brugge William R.,
Deshpande Vikram
Publication year - 2008
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.23346
Subject(s) - medicine , serous cystadenoma , serous fluid , pancreas , hemosiderin , pathology , cyst , carcinoembryonic antigen , biopsy , radiology , cystadenoma , endoscopic ultrasound , cytology , cancer
BACKGROUND Expectant management of serous cystadenoma (SCA) of the pancreas requires an accurate preoperative diagnosis. Previously published cytologic diagnostic sensitivities have ranged widely, from 10% to 100%. In the current study, the authors evaluated the diagnostic sensitivity of endoscopic ultrasound (EUS)‐guided fine‐needle aspiration biopsy (FNAB) and cross‐sectional imaging for SCA. METHODS Group I consisted of 21 histologically confirmed SCAs. Group II (n = 7 lesions) lacked histologic confirmation and was defined by EUS findings that were consistent with SCA and a cyst fluid carcinoembryonic antigen (CEA) level <5 ng/mL. Group III was comprised of 2 nonserous and potentially malignant cysts of the pancreas for which a preoperative diagnosis of SCA was considered. Cross‐sectional imaging data were recorded. The smears were evaluated for the presence of serous lining epithelium, gastrointestinal‐contaminating epithelium, and inflammatory cells including hemosiderin‐laden macrophages. The authors also evaluated the presence of hemosiderin‐laden macrophages in a series of 110 FNA specimens from histologically confirmed neoplastic mucinous cysts of the pancreas and 45 pseudocysts of the pancreas. RESULTS Prospectively among Group I lesions, the appearance on computed tomography (CT) was considered definitive for SCA in 3 of 12 cases (25%). The histologically confirmed SCA cases had CEA levels of <5 ng/mL, except for 1 case for which the CEA level was 176.5 ng/mL. A cytologic diagnosis of SCA was made prospectively in only 1 CT‐guided case. Retrospectively, 3 intraoperative FNAs and 1 additional CT‐guided aspirate contained rare epithelial cells of a SCA. None of the EUS‐guided aspirates demonstrated serous epithelium. Among Group II aspiration specimens, only 1 contained serous epithelial cells. Approximately 52% of the EUS‐guided aspirates demonstrated gastrointestinal contamination. This glandular epithelium was categorized as atypical in 2 cases. Hemosiderin‐laden macrophages were identified in 43% of the SCAs. Conversely, only 2% of neoplastic mucinous cysts and 9% of pseudocysts produced hemosiderin‐laden macrophages in aspirate fluid. CONCLUSIONS In the current study, serous epithelial cells were identified in <20% of cases. Gastrointestinal‐contaminating epithelium, often observed in EUS‐guided aspirates, further contributes to difficulties in interpretation. The presence of hemosiderin‐laden macrophages as a surrogate marker for SCA requires further study. A preoperative diagnosis of SCA remains a challenge, and an EUS‐guided FNAB is unlikely to provide the high level of diagnostic accuracy necessary to permit a nonoperative approach. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.