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Endoscopic ultrasound-guided fine-needle aspiration cytology in the diagnosis of intraductal papillary mucinous neoplasms of the pancreas. A study of 8 cases.
JOP 2007; 8(6):715-24JOP

Abstract

CONTEXT

Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized neoplasm of the pancreas, accounting for 5% of pancreatic neoplasms, it is considered difficult to diagnose by fine-needle aspiration (FNA) cytology.

OBJECTIVE

The aim of this study was to investigate the role of EUS-guided FNA cytology in the diagnosis of IPMN of the pancreas.

PATIENTS

Eight cases of surgically proven IPMN with pre-operative endoscopic ultrasound-guided (EUS-guided) FNA cytology were collected for retrospective analysis.

MAIN OUTCOME MEASURES

EUS-FNA cytology was performed with the on-site attendance of a cytopathologist in all cases. EUS/clinical findings, macroscopic/microscopic features of cell blocks and smears, and immunocytochemical stains accompanied by histopathologic diagnosis were recorded and studied.

RESULTS

EUS revealed hypoechoic masses in the head of pancreas (n=6) and in the body/tail (n=2), measuring from 16.6 to 35.8 mm. In all cases, the hypoechoic mass had a distinctive distribution, involving the main pancreatic duct and/or the associated large branch ducts while intraductal nodules or multiple cysts were detected. Cytological specimens were characterized by a background containing abundant mucin in all cases and rarely by inflammation (neutrophils and histiocytes) (n=4). Neoplastic cells were entrapped in a mucinous background either single or loosely cohesive, and forming papillae in 7 cases. Mucinous epithelium was observed in all cases. Single atypical and irregular clusters were found in 3 cases (which were cytologically described as highly suggestive malignant IPMNs, and were histologically confirmed). Two cases were diagnosed as benign IPMN and, in 3 cases, the biological behavior was not easy to determine by cytology alone (histologically diagnosed as borderline). The histological diagnosis confirmed the FNA cytology diagnosis: 3 malignant IPMNs, 2 benign IPMNs and 3 borderline IPMNs. Immunostains were available in 5 out of 8 cases. Mucin 1 (MUC-1) was positive in 2 cases of malignant IPMN (histologically classified as null type ad intestinal type), mucin 2 (MUC-2) was positive in 3 cases (2 malignant both of the intestinal type, and 1 benign of the intestinal type I) and c-erbB2 was positive in 3 cases (2 benign - null and intestinal type - and 1 malignant null type).

CONCLUSIONS

The characteristic pre-operative EUS findings and cytomorphologic features, in addition to the immunocytochemical profile, were accurate indications and coincided with the final/post-operative histological diagnosis of IPMN.

Authors+Show Affiliations

Department of Cytology, Athens General Hospital, Athens, Greece.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17993724

Citation

Salla, Charitini, et al. "Endoscopic Ultrasound-guided Fine-needle Aspiration Cytology in the Diagnosis of Intraductal Papillary Mucinous Neoplasms of the Pancreas. a Study of 8 Cases." JOP : Journal of the Pancreas, vol. 8, no. 6, 2007, pp. 715-24.
Salla C, Chatzipantelis P, Konstantinou P, et al. Endoscopic ultrasound-guided fine-needle aspiration cytology in the diagnosis of intraductal papillary mucinous neoplasms of the pancreas. A study of 8 cases. JOP. 2007;8(6):715-24.
Salla, C., Chatzipantelis, P., Konstantinou, P., Karoumpalis, I., Sakellariou, S., Pantazopoulou, A., & Manika, Z. (2007). Endoscopic ultrasound-guided fine-needle aspiration cytology in the diagnosis of intraductal papillary mucinous neoplasms of the pancreas. A study of 8 cases. JOP : Journal of the Pancreas, 8(6), pp. 715-24.
Salla C, et al. Endoscopic Ultrasound-guided Fine-needle Aspiration Cytology in the Diagnosis of Intraductal Papillary Mucinous Neoplasms of the Pancreas. a Study of 8 Cases. JOP. 2007 Nov 9;8(6):715-24. PubMed PMID: 17993724.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic ultrasound-guided fine-needle aspiration cytology in the diagnosis of intraductal papillary mucinous neoplasms of the pancreas. A study of 8 cases. AU - Salla,Charitini, AU - Chatzipantelis,Paschalis, AU - Konstantinou,Panagiotis, AU - Karoumpalis,Ioannis, AU - Sakellariou,Stratigoula, AU - Pantazopoulou,Akrivi, AU - Manika,Zisoula, Y1 - 2007/11/09/ PY - 2007/11/13/pubmed PY - 2007/12/11/medline PY - 2007/11/13/entrez SP - 715 EP - 24 JF - JOP : Journal of the pancreas JO - JOP VL - 8 IS - 6 N2 - CONTEXT: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized neoplasm of the pancreas, accounting for 5% of pancreatic neoplasms, it is considered difficult to diagnose by fine-needle aspiration (FNA) cytology. OBJECTIVE: The aim of this study was to investigate the role of EUS-guided FNA cytology in the diagnosis of IPMN of the pancreas. PATIENTS: Eight cases of surgically proven IPMN with pre-operative endoscopic ultrasound-guided (EUS-guided) FNA cytology were collected for retrospective analysis. MAIN OUTCOME MEASURES: EUS-FNA cytology was performed with the on-site attendance of a cytopathologist in all cases. EUS/clinical findings, macroscopic/microscopic features of cell blocks and smears, and immunocytochemical stains accompanied by histopathologic diagnosis were recorded and studied. RESULTS: EUS revealed hypoechoic masses in the head of pancreas (n=6) and in the body/tail (n=2), measuring from 16.6 to 35.8 mm. In all cases, the hypoechoic mass had a distinctive distribution, involving the main pancreatic duct and/or the associated large branch ducts while intraductal nodules or multiple cysts were detected. Cytological specimens were characterized by a background containing abundant mucin in all cases and rarely by inflammation (neutrophils and histiocytes) (n=4). Neoplastic cells were entrapped in a mucinous background either single or loosely cohesive, and forming papillae in 7 cases. Mucinous epithelium was observed in all cases. Single atypical and irregular clusters were found in 3 cases (which were cytologically described as highly suggestive malignant IPMNs, and were histologically confirmed). Two cases were diagnosed as benign IPMN and, in 3 cases, the biological behavior was not easy to determine by cytology alone (histologically diagnosed as borderline). The histological diagnosis confirmed the FNA cytology diagnosis: 3 malignant IPMNs, 2 benign IPMNs and 3 borderline IPMNs. Immunostains were available in 5 out of 8 cases. Mucin 1 (MUC-1) was positive in 2 cases of malignant IPMN (histologically classified as null type ad intestinal type), mucin 2 (MUC-2) was positive in 3 cases (2 malignant both of the intestinal type, and 1 benign of the intestinal type I) and c-erbB2 was positive in 3 cases (2 benign - null and intestinal type - and 1 malignant null type). CONCLUSIONS: The characteristic pre-operative EUS findings and cytomorphologic features, in addition to the immunocytochemical profile, were accurate indications and coincided with the final/post-operative histological diagnosis of IPMN. SN - 1590-8577 UR - https://www.unboundmedicine.com/medline/citation/17993724/Endoscopic_ultrasound_guided_fine_needle_aspiration_cytology_in_the_diagnosis_of_intraductal_papillary_mucinous_neoplasms_of_the_pancreas__A_study_of_8_cases_ L2 - http://www.joplink.net/prev/200711/08.html DB - PRIME DP - Unbound Medicine ER -