Pleomorphic and atypical multinucleated giant cells in solid pseudopapillary neoplasm of pancreas: A diagnostic pitfall in cytology and a review of the literature

Policarpio‐Nicolas, Maria Luisa; McHugh, Kelsey; Sae-Ow, Wichit; Brainard, Jennifer

doi:10.1002/dc.24129

Cited by 5 publications

(4 citation statements)

References 19 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As can be seen in Figure 3, the large atypical multinucleated neoplastic cells were immunoreactive for nuclear β-catenin, cyclin-D1, and PR, while they were negative for CK AE1/AE3 and chromogranin, with a low proliferation index, confirming the diagnosis of SPN. Similar giant cells have recently been described in a few reports [23][24][25]. Interestingly, all of our cases with atypical cells occurred in relatively older patients, leading to the consideration of pancreatic carcinoma.…”

Section: Discussionsupporting

confidence: 88%

Cytological Diagnosis of Pancreatic Solid-Pseudopapillary Neoplasm: A Single-Institution Community Practice Experience

2022

View full text Add to dashboard Cite

Introduction. Pancreatic solid-pseudopapillary neoplasm (SPN) is a rare tumor that typically occurs in young females. Although a cytological diagnosis may be easily made in this age group when there are typical features, atypical clinical presentations and unusual cytological features may make this a challenging diagnosis. We present our single-institution experience in a cohort of these tumors, outlining both typical and atypical features. Awareness of unusual clinical and cytological features can help to avoid pitfalls during diagnosis. Methods. We performed a review of all cases of pancreatic SPNs diagnosed over a 15-year period (January 2007 to December 2021). Detailed cytological, clinical, and follow-up histological features were presented and analyzed. Results. Twenty-two cases of SPN were diagnosed at our institution during this 15-year period. Patients ranged from 12 to 73 years of age (mean 33 y, median 26 y) and included 19 females and 3 males. Seventeen patients had cytological material, and fourteen were diagnosed by EUS-FNA. Typical cytological features included papillary clusters with central capillaries, myxoid stroma, monomorphism, cercariform cells, and hyaline globules. Atypical or unusual cytological features that were seen in a few cases were multinucleated giant cells, clear cells, and/or foamy macrophages. A few cases showed features that were similar to pancreatic neuroendocrine tumors (PanNETs). Tumor cells were always positive for β-catenin, CD10, CD56, cyclin-D1, progesterone receptor (PR), and vimentin by immunohistochemistry. They were always negative for chromogranin. Pancytokeratin and synaptophysin stains were positive in 9% and 46% of cases evaluated, respectively. All cases had histological confirmation on resection. The median follow-up duration was 69 months (a range of 2–177 months), with only three cases lost to follow-up. No recurrence or metastasis was identified. Conclusions. We present our experience with cytological diagnoses of SPN in a well-characterized cohort of 22 patients with histological correlation and follow-up data. These tumors occur over a wide range and show varied cytological features. SPNs can be confidently diagnosed on limited cytological material, with limited panel immunohistochemistry aiding diagnosis in atypical cases. Recognizing the associated degenerative changes is crucial in avoiding a misdiagnosis.

show abstract

Section: Discussionsupporting

confidence: 88%

Cytological Diagnosis of Pancreatic Solid-Pseudopapillary Neoplasm: A Single-Institution Community Practice Experience

2022

View full text Add to dashboard Cite

show abstract

“…SPN of the pancreas is an uncommon, low‐grade, malignant epithelioid neoplasm with cytomorphologic and IHC overlap with a wide array of entities spanning the biologic spectrum from benign neoplasms to highly aggressive malignancies. Particularly confounding is the presence of bizarre pleomorphism and atypical multinucleated giant cells, which are known to occur in a subset of SPNs . In the absence of classic clinical and cytomorphologic features, IHC plays an important role in distinguishing SPN from other tumors within the differential diagnosis, including pancreatic neuroendocrine tumor, acinar cell carcinoma, pancreatoblastoma, and pancreatic ductal adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

The usefulness of lymphoid enhancer‐binding factor 1 and androgen receptor in diagnosing solid pseudopapillary neoplasm of the pancreas on cytopathology

McHugh

Stelow

Harrison

et al. 2019

Cancer Cytopathology

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Solid pseudopapillary neoplasm (SPN) is an uncommon tumor that is challenging to diagnose on cytology due to morphologic overlap with other pancreatic neoplasms. Recently, putative diagnostic markers for SPN have been reported in the surgical pathology literature, with nuclear positivity for lymphoid enhancer-binding factor 1 (LEF1) and androgen receptor (AR) identified in >90% and >80% of cases, respectively. In the current study, the authors sought to evaluate the sensitivity and specificity of LEF1 and AR on SPN cytology specimens and available corresponding surgical resection specimens. METHODS: Immunohistochemistry was performed using monoclonal antibodies against LEF1 and AR on 19 SPN cytology cases and 15 corresponding follow-up surgical resection specimens from 2 institutions. To evaluate specificity, the authors stained 23 non-SPN tumors diagnosed on cytology with corresponding surgical specimens (4 acinar cell carcinomas, 9 pancreatic neuroendocrine tumors, and 10 ductal adenocarcinomas). Positivity for LEF1 and AR was defined as any nuclear staining within neoplastic nuclei. RESULTS: LEF1 was found to be positive in 18 of 19 cytology cases (94.7%) and 15 of 15 corresponding surgical resection specimens (100%). AR was positive in 4 of 16 cytology cases (25.0%) and 4 of 15 corresponding surgical resection specimens (26.7%). Among non-SPN tumors, LEF1 demonstrated a specificity of 87% whereas the specificity for AR was 100%. CONCLUSIONS: LEF1 for SPN on cytology material was found to demonstrate a sensitivity of 94.7% and a specificity of 87%. Although AR was found to have a specificity of 100%, its sensitivity was lower (25%). LEF1 could be a valuable immunostain on cytology cell block material for the diagnosis of SPN. However, the same may not hold true for AR.

show abstract

“…Ki-67 IHC was not pursued in our cytology case but was found to be low (<3%) in the resection specimen. It should be noted that randomly scattered pleomorphic cells (endocrine atypia) may be present in EUS-FNA samples from PanNETs, and pleomorphic and multinucleated cell have also been described in PSPPNs [24].…”

Section: Discussionmentioning

confidence: 99%

“…Overlap of cytomorphologic features between PanNETs and PSPPNs can result in difficulty when attempting to accurately classify EUS FNA samples, and in some instances ancillary IHC studies may not allow for exact classification, as the synaptophysin immunoreactivity expected in PanNETs may on occasion be present in PSPPNs, and spurious β -catenin immunoreactivity may be rarely encountered in PanNETs. A recent error reduction focused study of the cytologic criteria for the diagnosis of PSPPNs by EUS-FNA emphasized the presence of fine (and not coarsely granular) chromatin, nuclear grooves, pseudo papillae, pink stroma and small intracellular cytoplasmic hyaline globules as being statistically significantly associated with PSPPNs [24]. In our case of an FNA of a gyriform PanNET with an exaggerated cobblestone-like pattern of growth, a pseudopapillary pattern was considered because of the stromal spheroids with intrinsic fibroblasts, and in some areas pink stroma was noted.…”

Section: Discussionmentioning

confidence: 99%

Fibrous Extracellular Spheroids in an Endoscopic Ultrasound-Guided Pancreatic Fine Needle Aspiration Correlating to a Gyriform Pancreatic Endocrine Tumor with a Unique Cobblestone Pavement Growth Pattern

Marotta

Reynolds

Plesec

et al. 2019

Case Reports in Pathology

View full text Add to dashboard Cite

Pancreatic neuroendocrine neoplasms (PanNENs) are uncommon tumors. Fine needle aspiration (FNA) samples from PanNENs are typically of high cellularity and lack necrosis. In cytology slides from these tumors, dyscohesive cells are usually reported with variably round to oval to plasmacytoid forms exhibiting coarsely granular chromatin and showing immunoreactivity for synaptophysin. We present an unusual, and to our knowledge not previously described, example of an FNA of a PanNEN with large extracellular fibrous spheroids containing intrinsic fibroblasts and rimmed by small to intermediate sized neoplastic epithelial cells with high nuclear cytoplasmic ratios. The cytomorphology of the PanNEN in this case was in some ways reminiscent of that expected in adenoid cystic carcinomas of the salivary glands that most often contain large extracellular globules of basement membrane material and a somewhat biphasic population of lesional cells. The cytomorphology in this case was found to correlate well with the resection specimen histomorphology of an exaggerated gyriform pattern of growth resulting in a unique cobblestone-pavement like microscopic appearance. Knowledge of this potential cytomorphology will aid the cytology community through recognition and reporting of this previously undescribed pattern in an uncommon disease.

show abstract

Pleomorphic and atypical multinucleated giant cells in solid pseudopapillary neoplasm of pancreas: A diagnostic pitfall in cytology and a review of the literature

Cited by 5 publications

References 19 publications

Cytological Diagnosis of Pancreatic Solid-Pseudopapillary Neoplasm: A Single-Institution Community Practice Experience

Cytological Diagnosis of Pancreatic Solid-Pseudopapillary Neoplasm: A Single-Institution Community Practice Experience

The usefulness of lymphoid enhancer‐binding factor 1 and androgen receptor in diagnosing solid pseudopapillary neoplasm of the pancreas on cytopathology

Fibrous Extracellular Spheroids in an Endoscopic Ultrasound-Guided Pancreatic Fine Needle Aspiration Correlating to a Gyriform Pancreatic Endocrine Tumor with a Unique Cobblestone Pavement Growth Pattern

Contact Info

Product

Resources

About