Ancillary studies in fna of liver and pancreas

Abstract

biopsy of the liver and pancreas is the evaluation of mass lesions. In the majority of FNA biopsies from both sites, an accurate diagnosis can be rendered based on cytologic features. However, in occasional cases, ancillary studies can prove quite useful in making a specific diagnosis. Although ancillary studies have a limited to nonexistent role in the FNA evaluation of most benign liver lesions, it can be quite helpful in differentiating primary liver neoplasms from metastatic malignancies. A discussion of the role of ancillary studies in the workup of both common and unusual liver malignancies will be presented. In pancreatic aspirates, ancillary studies are generally not needed for the diagnosis of the common, ductal type of pancreatic carcinoma. However, special studies such as immunocytochemistry and electron microscopy can be valuable in the workup of a variety of unusual pancreatic neoplasms as well as in the diagnosis of metastatic malignancies to the pancreas. Ancillary studies including biochemical assays for carcinoernbryonic antigen (CEA) and amylase can contribute to examination of cystic lesions of the pancreas.We recommend performance of an immediate interpretation to identify those selected cases benefiting from additional ancillary studies. I s 2 The following is a discussion of the role of ancillary studies in the FNA work of hepatic and pancreatic lesions. LiverThe major indication for FNA of the liver is in the evaluation of a hepatic mass. 3-16 In a number of large series of hepatic aspirates, most patients have had metastatic malignancies, although some recent papers report the accuracy of FNA biopsy for the diagnosis of primary

Fine‐needle aspiration cytology of pancreatoblastoma

“…21 Separation of these other tumors from pancreatoblastoma can usually be made on cytology as well as use on immunohistochemistry or ultrastructural studies and clinical and radiographic information. Acinar-cell carcinoma usually occurs in adults 26 and is cytologically characterized by relatively uniform polygonal cells with a round to oval nucleus, 26 -28 prominent nucleoli, 29 finely granular to vacuolated cytoplasm, 26,29 and the formation of acinar structures. 27,29 Immunohistochemical features of acinar-cell carcinoma include staining for cytokeratins and trypsin, 26,29 and ultrastructural analysis shows zymogen granules.…”

“…Acinar-cell carcinoma usually occurs in adults 26 and is cytologically characterized by relatively uniform polygonal cells with a round to oval nucleus, 26 -28 prominent nucleoli, 29 finely granular to vacuolated cytoplasm, 26,29 and the formation of acinar structures. 27,29 Immunohistochemical features of acinar-cell carcinoma include staining for cytokeratins and trypsin, 26,29 and ultrastructural analysis shows zymogen granules. 26 -29 Pancreatoblastoma may be difficult to separate from acinar-cell carcinoma by cytology, even with immunohistochemistry and ultrastructural analysis; however, the presence of squamoid corpuscles, as identified readily on the cell block material in this case, is seen only in pancreatoblastoma.…”

“…30,31 and lack of acinar differentiation or squamous corpuscles that are commonly seen in pancreatoblastoma. Solid and cystic epithelial neoplasms usually occur in girls and young women, 32 and are cytologically characterized by abundant small cuboidal cells with finely granular chromatin and small nucleoli 32 and frequent papillary-like 29,32,33 and rosette-like clusters. 29,33 Immunohistochemistry shows solid and cystic epithelial neoplasms to stain for vimentin, alpha-1-antitrypsin, alpha-1-antichymot-rypsin, and neuron-specific enolase, and show no significant staining for cytokeratin.…”

“…Solid and cystic epithelial neoplasms usually occur in girls and young women, 32 and are cytologically characterized by abundant small cuboidal cells with finely granular chromatin and small nucleoli 32 and frequent papillary-like 29,32,33 and rosette-like clusters. 29,33 Immunohistochemistry shows solid and cystic epithelial neoplasms to stain for vimentin, alpha-1-antitrypsin, alpha-1-antichymot-rypsin, and neuron-specific enolase, and show no significant staining for cytokeratin. 32 Pancreatoblastoma will not contain papillary-like clusters of cells and will show cytokeratin staining that is usually absent in solid and cystic epithelial neoplasm.…”

Small-cell tumors of the liver: A cytological study of 91 cases and a review of the literature

“…The presence of liver cirrhosis and a high level of a -fetoprotein (AFP), as well as immunostain studies, may be very helpful in reaching the diagnosis of HCC. A typical panel of immunostains13,14,15 may include…”