Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology Diagnosis of Solid-Pseudopapillary Tumor of the Pancreas : A Rare Neoplasm of Elusive Origin but Characteristic Cytomorphologic Features

Bardales, Ricardo H.; Centeno, Barbara A.; Mallery, J. Shawn; Lai, Rebecca; Pochapin, Mark; Guiter, Gerardo; Stanley, Michael W.

doi:10.1309/dkk2-b9v4-n0w2-6a8q

Cited by 94 publications

(112 citation statements)

References 52 publications

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“…In recent years various cases of solid pseudopapillary tumor have been described where ICC reached the right diagnosis on EUS- FNA-collected samples (30)(31)(32)(33): most were vimentin+ and cytokeratin+, whereas chomogranin and NSE were negative (they may be focally positive though) (34).…”

Section: Discussionmentioning

confidence: 99%

Definitive diagnosis of neuroendocrine tumors using fine-needle aspiration-puncture guided by endoscopic ultrasonography

Gornals

Varas²,

Català

et al. 2011

Rev. esp. enferm. dig.

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Background: the detection and diagnosis of neuroendocrine tumors (NETs) is challenging. Endoscopic ultrasonography (EUS) has a significant role in the detection of NETs suspected from clinical manifestations or imaging techniques, as well as in their precise localization and cytological confirmation using EUS-Fineneedle aspiration-puncture (FNA).Objective: to assess the usefulness and precision of EUS-FNA in the differential diagnosis and confirmation of NETs, in a retrospective review of our experience.Patients and methods: in a total of 55 patients with suspected NETs who underwent radial or sectorial EUS, 42 tumors were detected in 40 cases. EUS-FNA using a 22G needle was performed for 16 cases with suspected functional (hormonal disorders: 6 cases) and non-functional NETs (10 cases). Ki 67 or immunocytochemistry (ICC) testing was performed for all.There was confirmation in 9 cases (5 female and 4 male) with a mean age of 51 years (range: 41-81 years).All tumors were located in the pancreas except for one in the mediastinum and one in the rectum, with a mean size of 19 mm (range: 10-40 mm).Results: there were no complications attributable to FNA. Sensitivity was 100% and both precision and PPV were 89%, as a false positive result suggested a diagnosis with NET during cytology that surgery finally revealed to be a pancreatic pseudopapillary solid tumor.Conclusions: EUS-FNA with a 22G needle for NETs has high sensitivity and PPV at cytological confirmation with few complications.

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Section: Discussionmentioning

confidence: 99%

Definitive diagnosis of neuroendocrine tumors using fine-needle aspiration-puncture guided by endoscopic ultrasonography

Gornals

Varas²,

Català

et al. 2011

Rev. esp. enferm. dig.

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“…Bardales et al reported what to our knowledge is 1 of the larger case series pooled from more than 1 institution. 15 In their report, 5 of 6 cases of SPN were initially considered to be either PEN or another low-grade tumor. Similar to their report, 3 of the 5 SPN cases in the current study initially were considered as either PEN or suspicious for PEN by unsuspecting pathologists.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12][13] SPN is a pancreatic neoplasm whose cytologic features have been characterized previously. [14][15][16][17] Despite this, SPN continues to pose significant diagnostic challenges, even for experienced and often unsuspecting cytopathologists. In the current study, we report that recognition of clear cytoplasmic vacuoles in EUS-FNA samples are a useful clue with which to distinguish SPN from its closest morphologic mimicker, pancreatic endocrine neoplasm (PEN).…”

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confidence: 99%

Large, clear cytoplasmic vacuolation

Jhala

Siegal

Jhala

2008

Cancer

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BACKGROUND. Solid pseudopapillary neoplasm (SPN) and pancreatic endocrine neoplasm (PEN) are uncommon neoplasms that demonstrate characteristic cytologic features. It is also known that both these tumors may share similar morphologic changes. These features not uncommonly pose significant diagnostic challenge for unsuspecting cytopathologists. In the current study, the authors report that recognition of clear cytoplasmic vacuoles in endoscopic ultrasound–guided fine–needle aspiration (EUS‐FNA) samples from SPN serves as a useful clue that can distinguish this tumor from PEN. METHODS. The cytologic features from 5 SPN and 20 PEN cases were evaluated. Both Diff‐Quik and Papanicolaou stains from these cases were examined. A Fisher exact test of probability was performed to determine differences in the individual cytologic features noted in these 2 tumor types. RESULTS. The results demonstrated that pseudopapillary groups (P = .004); metachromatic matrix material (P = .004); nuclear membrane irregularity (P = .004); and large, clear cytoplasmic vacuoles (P = .001) are noted significantly more frequently in SPN. The authors also demonstrated that large, clear cytoplasmic vacuoles can serve as a powerful cytologic clue for the suspicion of SPN over PEN when there is a paucity of papillary groups within the smears. Large, clear cytoplasmic vacuoles, however, were noted only in Diff‐Quik–stained smears, but not in Papanicolaou‐;stained smears. CONCLUSIONS. The results of the current study highlight that large, clear cytoplasmic vacuoles can serve as a critical clue with which to distinguish SPN from PEN in diagnostically challenging cases. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.

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“…EUS-guided FNA cytological analysis reveals characteristic branching papillae with myxoid stroma, best seen in cellblock material (33). When identified, regardless of the stage, resection should be considered.…”

Section: Solid Pseudopapillary Tumorsmentioning

confidence: 99%

ACG Practice Guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts

Khalid¹,

Brugge²

2007

Am J Gastroenterology

290

197

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The diagnosis and management of pancreatic cystic lesions is a common problem. At least 1% of hospitalized patients at major medical centers will have a pancreatic cystic lesion on cross sectional imaging. Up to a quarter of all pancreata examined in an autopsy series contained a pancreatic cyst, 16% of which were lined by an "atypical" epithelium and 3% of which had progressed to carcinoma-in-situ (high grade dysplasia). in the past, it was thought these cystic lesions were benign, but increasing evidence points to the cystic lesions as being the origin of some pancreatic malignancies.The most important clinical tools in the diagnosis and management of pancreatic cystic lesions are cross sectional imaging, endoscopic ultrasound, and cyst fluid analysis. The most important differential diagnosis is distinguishing mucinous (pre-malignant) and non-mucinous cystic lesions. The findings of a macrocystic lesion containing viscous fluid rich in CEA are supportive of a diagnosis of a mucinous lesion. Serous lesion are the most common non-mucinous cyst and are characterized by a microcystic morphology, non-viscous fluid and a low concentration of CEA in the cyst fluid.The following document includes a description of neoplastic pancreatic cysts, a critical review of relevant diagnostic tests, and a discussion of treatment options. We have proposed a set of guidelines for the diagnonis and management of patients with neoplastic pancreatic cysts. The guidelines are based on published data backed by an analysis of the quality of the data and are designed to address the most frequent and important clinical scenarios. In addition to providing a summary of the diagnostic data, we offer diagnostic and management suggestions based on 13 common clinical problems. Although the field is rapidly evolving, a set of core principles is provided based on a balance between the risk of malignancy and the benefit of pancreatic resection.

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Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology Diagnosis of Solid-Pseudopapillary Tumor of the Pancreas : A Rare Neoplasm of Elusive Origin but Characteristic Cytomorphologic Features

Cited by 94 publications

References 52 publications

Definitive diagnosis of neuroendocrine tumors using fine-needle aspiration-puncture guided by endoscopic ultrasonography

Definitive diagnosis of neuroendocrine tumors using fine-needle aspiration-puncture guided by endoscopic ultrasonography

Large, clear cytoplasmic vacuolation

ACG Practice Guidelines for the Diagnosis and Management of Neoplastic Pancreatic Cysts

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