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Cytopathologic diagnosis of oncocytic type intraductal papillary mucinous neoplasm: Criteria and clinical implications of accurate diagnosis.
Cancer Cytopathol 2016; 124(2):122-34CC

Abstract

BACKGROUND

Cytologic findings of pancreatic oncocytic-type intraductal papillary mucinous neoplasms (IPMNs)/intraductal oncocytic papillary neoplasms (IOPNs) are largely unknown.

METHODS

Five IOPNs encountered by the authors were analyzed.

RESULTS

Four IOPNs were located in the pancreatic head, and 1 was located in the pancreatic body/tail in 2 men and 3 women ages 56 to 84 years (mean age, 66 years). Radiologic diagnoses included pancreatic ductal adenocarcinoma (PDAC) in 2 patients, invasive cancer associated with IPMN in 1 patient, IPMN versus mucinous cystic neoplasm in 1 patient, and cystic mass in 1 patient. Cytologic findings included: hypercellular smears (4 of 5 cases) containing well formed clusters of oncocytic cells (5 of 5 cases) with prominent, slightly eccentric nucleoli (4 of 5 cases), predominantly arranged in sheets/papillary units (5 of 5 cases), with punched-out intercytoplasmic spaces (4 of 5 cases), and with occasional 3-dimensional groups and focal necrosis (3 of 5 cases). The intracytoplasmic mucin and thick extracellular mucin typical of other IPMNs were observed only in 2 cases and were very limited. The mean size on resection was 4.5 cm. Invasion was observed in 3 cases (0.1, 0.3, and 2.0 cm) of tubular-type IPMN. Initial cytologic evaluation was performed by the authors in 4 of 5 cases, which were diagnosed as IOPN (n = 3) and IPMN versus cystic PDAC (n = 1). One case was initially misdiagnosed as PDAC and, on resection, proved to be noninvasive IOPN.

CONCLUSIONS

Cytologic features of IOPNs are classical, similar to their histologic counterparts, and differ significantly from other IPMN subtypes. Because of their highly complex appearance, they are often radiologically misdiagnosed as PDAC; thus, failure to recognize their characteristic features on fine-needle aspiration may lead to inappropriate treatment. Patients with IOPN have an incomparably better prognosis than patients with ordinary PDAC, even when their neoplasms are invasive.

Authors+Show Affiliations

Department of Pathology, Emory University School of Medicine, Atlanta, Georgia.Department of Pathology, Emory University School of Medicine, Atlanta, Georgia.Department of Pathology, Emory University School of Medicine, Atlanta, Georgia.Department of Pathology, Emory University School of Medicine, Atlanta, Georgia.Department of Pathology, Emory University School of Medicine, Atlanta, Georgia.Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.Department of Pathology, Emory University School of Medicine, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26415076

Citation

Reid, Michelle D., et al. "Cytopathologic Diagnosis of Oncocytic Type Intraductal Papillary Mucinous Neoplasm: Criteria and Clinical Implications of Accurate Diagnosis." Cancer Cytopathology, vol. 124, no. 2, 2016, pp. 122-34.
Reid MD, Stallworth CR, Lewis MM, et al. Cytopathologic diagnosis of oncocytic type intraductal papillary mucinous neoplasm: Criteria and clinical implications of accurate diagnosis. Cancer Cytopathol. 2016;124(2):122-34.
Reid, M. D., Stallworth, C. R., Lewis, M. M., Akkas, G., Memis, B., Basturk, O., & Adsay, V. (2016). Cytopathologic diagnosis of oncocytic type intraductal papillary mucinous neoplasm: Criteria and clinical implications of accurate diagnosis. Cancer Cytopathology, 124(2), pp. 122-34. doi:10.1002/cncy.21627.
Reid MD, et al. Cytopathologic Diagnosis of Oncocytic Type Intraductal Papillary Mucinous Neoplasm: Criteria and Clinical Implications of Accurate Diagnosis. Cancer Cytopathol. 2016;124(2):122-34. PubMed PMID: 26415076.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cytopathologic diagnosis of oncocytic type intraductal papillary mucinous neoplasm: Criteria and clinical implications of accurate diagnosis. AU - Reid,Michelle D, AU - Stallworth,Christina R, AU - Lewis,Melinda M, AU - Akkas,Gizem, AU - Memis,Bahar, AU - Basturk,Olca, AU - Adsay,Volkan, Y1 - 2015/09/28/ PY - 2015/05/22/received PY - 2015/08/07/revised PY - 2015/08/21/accepted PY - 2015/9/29/entrez PY - 2015/9/29/pubmed PY - 2016/6/28/medline KW - cytology KW - fine-needle aspiration KW - intraductal oncocytic papillary neoplasm (IOPN) KW - intraductal papillary mucinous neoplasm (IPMN) KW - oncocytic KW - oncocytic intraductal papillary mucinous neoplasm KW - pancreas SP - 122 EP - 34 JF - Cancer cytopathology JO - Cancer Cytopathol VL - 124 IS - 2 N2 - BACKGROUND: Cytologic findings of pancreatic oncocytic-type intraductal papillary mucinous neoplasms (IPMNs)/intraductal oncocytic papillary neoplasms (IOPNs) are largely unknown. METHODS: Five IOPNs encountered by the authors were analyzed. RESULTS: Four IOPNs were located in the pancreatic head, and 1 was located in the pancreatic body/tail in 2 men and 3 women ages 56 to 84 years (mean age, 66 years). Radiologic diagnoses included pancreatic ductal adenocarcinoma (PDAC) in 2 patients, invasive cancer associated with IPMN in 1 patient, IPMN versus mucinous cystic neoplasm in 1 patient, and cystic mass in 1 patient. Cytologic findings included: hypercellular smears (4 of 5 cases) containing well formed clusters of oncocytic cells (5 of 5 cases) with prominent, slightly eccentric nucleoli (4 of 5 cases), predominantly arranged in sheets/papillary units (5 of 5 cases), with punched-out intercytoplasmic spaces (4 of 5 cases), and with occasional 3-dimensional groups and focal necrosis (3 of 5 cases). The intracytoplasmic mucin and thick extracellular mucin typical of other IPMNs were observed only in 2 cases and were very limited. The mean size on resection was 4.5 cm. Invasion was observed in 3 cases (0.1, 0.3, and 2.0 cm) of tubular-type IPMN. Initial cytologic evaluation was performed by the authors in 4 of 5 cases, which were diagnosed as IOPN (n = 3) and IPMN versus cystic PDAC (n = 1). One case was initially misdiagnosed as PDAC and, on resection, proved to be noninvasive IOPN. CONCLUSIONS: Cytologic features of IOPNs are classical, similar to their histologic counterparts, and differ significantly from other IPMN subtypes. Because of their highly complex appearance, they are often radiologically misdiagnosed as PDAC; thus, failure to recognize their characteristic features on fine-needle aspiration may lead to inappropriate treatment. Patients with IOPN have an incomparably better prognosis than patients with ordinary PDAC, even when their neoplasms are invasive. SN - 1934-6638 UR - https://www.unboundmedicine.com/medline/citation/26415076/Cytopathologic_diagnosis_of_oncocytic_type_intraductal_papillary_mucinous_neoplasm:_Criteria_and_clinical_implications_of_accurate_diagnosis_ L2 - https://doi.org/10.1002/cncy.21627 DB - PRIME DP - Unbound Medicine ER -