Crystals in a pancreatic endoscopic ultrasound‐guided fine needle aspirate

Abstract

A previously healthy 37-year-old man first presented 2 years prior to the current admission with acute onset of abdominal pain, for which he underwent emergent cholecystectomy. The postoperative course was however, marked by increasingly severe right upper quadrant pain leading to his current admission. The patient had normal laboratory values, including CBC, amylase, and lipase on several occasions, but had mildly elevated AST, ALT, and serum calcium levels. On endoscopic retrograde cholangiopancreatography (ERCP) with sphincter of Oddi manometry, the pancreatic sphincter basal pressure was elevated, suggestive of sphincter dysfunction. The bile duct was dilated to 12 mm. EUS showed no mass lesions, but identified two simple pancreatic cystic structures with ultrasound features of pseudocysts measuring 0.8 3 0.5 and a 0.3 3 0.2 cm. The larger cyst was aspirated, returning one milliliter of clear fluid, from which Diff-Quik and Papanicolaou-stained smears, cytospins and cell block preparations were made. The quantity of aspirated fluid was insufficient to perform amylase and CEA determinations.

Fine‐needle aspiration of a pancreas with squamoid cyst of pancreatic duct and pancreatic duct stones: A case report of a rare pancreatic lesion and an unusual concurrent finding of stone‐related crystals

“…Crystals are not typically seen in aspirates of pancreatic lesions. Cholesterol crystals, 5 amylase crystalloid 10 and gouty tophi 11 have been described in benign squamous cysts, pseudocyst, or non‐neoplastic pancreas. In our case, the crystals from the pancreatic FNA (Figure 2) do not resemble plate‐shaped cholesterol crystals and are birefringent unlike amyloid crystalloid.…”

Crystals Identified by Endoscopic Ultrasound–Guided Needle-Based Confocal Laser Endomicroscopy in a Pancreatic Pseudocyst

“…[1][2][3][4][5] Cholesterol crystals are the most prevalent among these, but reports also describe the presence of needle-shaped negatively birefringent crystals, bile-containing crystals, Charcot-Leyden crystals, and Reinke-like crystals. [1][2][3][4][5] The pathophysiology of crystal formation remains largely unclear, but it is likely associated with both the crystal composition and underlying pancreatic disease. For instance, cholesterol crystals are believed to develop through the breakdown of blood within and around the pancreas, resulting in an accumulation of cholesterol in the affected area.…”

“…Crystals are observed in benign PCLs such as cholesterol granulomas, pseudocysts, and squamous-lined cysts (lymphoepithelial cysts). [1][2][3][4][5] Cholesterol crystals are the most prevalent among these, but reports also describe the presence of needle-shaped negatively birefringent crystals, bile-containing crystals, Charcot-Leyden crystals, and Reinke-like crystals. [1][2][3][4][5] The pathophysiology of crystal formation remains largely unclear, but it is likely associated with both the crystal composition and underlying pancreatic disease.…”