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Spindle cell neoplasms of the upper gastrointestinal tract, hepatobiliary tract, and pancreas by fine needle aspiration: A single institutional experience of 15 years with follow‐up data
Author(s) -
McHugh Kelsey E,
Odronic Shelley I,
Smith Amber,
Springer Bridgette,
Aramouni Ghada,
Chute Deborah J,
Reynolds Jordan P
Publication year - 2021
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.24801
Subject(s) - medicine , malignancy , pancreas , fine needle aspiration , gist , pathology , biopsy , esophagus , surgical pathology , gastrointestinal tract , radiology , stromal cell
Background The diagnosis of spindle cell neoplasms (SCN) of the upper gastrointestinal (GI) tract, hepatobiliary tract, and pancreas detected by fine needle aspiration (FNA) is challenging. We describe a single‐center experience of these samples with follow‐up data and characterization of the morphologic findings. Methods We retrospectively reviewed pathology records for all FNAs diagnostic for or suggestive of SCN on esophagus, stomach, small bowel, liver, and pancreas in a 15 year period. All cases with at least 6 month follow‐up were included. Surgical material (biopsy or resection) was the diagnostic gold standard. All FNAs with subsequent surgical specimens were reviewed and assessed for cellularity, architectural features, and nuclear features. Results In 15 years, 5101 FNAs of the upper GI tract, hepatobiliary tract, and pancreas were performed. SCN was diagnosed in 98 (2%) patients. Seventy‐two patients had definitive pathologic diagnoses: 68 were neoplastic and four were non‐neoplastic. Cytomorphologic review in relationship to final diagnosis revealed three statistically significant features: low cellularity favors a benign process ( P = .00544), epithelioid nuclear morphology favors malignancy ( P = .00278), and identification of perinuclear vacuoles favors a diagnosis of GIST over non‐GIST SCN ( P = .04236). Conclusions Among cases with follow‐up, final pathologic diagnoses were SCN in 94% of cases diagnosed as SCN on FNA of upper GI, hepatobiliary tract, and pancreas. Although some cytomorphologic criteria are more suggestive of malignancy, arriving at a specific diagnosis relies on collaboration of clinical, radiologic, cytomorphologic, and immunohistochemical data.