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Pancreas

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Atlas of Fine Needle Aspiration Cytology

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Abstract

Preoperative biopsy of pancreatic masses and cysts is performed to provide a diagnosis and direct patient management, which ranges from conservative observation to surgery. Increasingly, neoadjuvant chemotherapy and/or radiation therapy has been used to treat resectable and borderline resectable cancers due to its ability to induce tumor regression, treat micro-metastases, and reduce the risk of positive margins and peritoneal implantation on resection. Endoscopic ultrasound and fine-needle aspiration sampling (EUS-FNA) has become the favored method of biopsy over the past decade. This method has many advantages over percutaneous FNA but introduces challenges with gastrointestinal contamination. For the pathologist, the differential diagnosis of a pancreatic mass will be focused by the patient’s history and imaging characteristics of the lesion (solid versus cystic). This chapter outlines the various solid and cystic lesions of the pancreas emphasizing proper tissue triage and handling, cytological criteria, and a multimodal approach to diagnosis using clinical and imaging features, as well as ancillary pathological studies. The newly proposed Papanicolaou Society of Cytopathology terminology system for reporting pancreaticobiliary cytology is also discussed.

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References

  1. National Cancer Institute. https://seer.cancer.gov/statfacts/html/pancreas.html. Accessed 8 Jan 2017.

  2. Zhan H-X, Xu J-W, Wu D, et al. Neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of prospective studies. Cancer Med. 2017;6:1201–19.

    Article  CAS  Google Scholar 

  3. Pitman MB, Deshpande V. Endoscopic ultrasound-guided fine needle aspiration cytology of the pancreas: a morphological and multimodal approach to the diagnosis of solid and cystic mass lesions. Cytopathology. 2007;18:331–47. https://doi.org/10.1111/j.1365-2303.2007.00457.x.

    Article  CAS  PubMed  Google Scholar 

  4. Okasha HH, Naga MI, Esmat S, et al. Endoscopic ultrasound-guided fine needle aspiration versus percutaneous ultrasound-guided fine needle aspiration in diagnosis of focal pancreatic masses. Endosc Ultrasound. 2013;2:190–3. https://doi.org/10.4103/2303-9027.121239.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Matsuyama M, Ishii H, Kuraoka K, et al. Ultrasound-guided vs endoscopic ultrasound-guided fine-needle aspiration for pancreatic cancer diagnosis. World J Gastroenterol. 2013;19:2368–73. https://doi.org/10.3748/wjg.v19.i15.2368.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Affolter KE, Schmidt RL, Matynia AP, et al. Needle size has only a limited effect on outcomes in EUS-guided fine needle aspiration: a systematic review and meta-analysis. Dig Dis Sci. 2013;58:1026–34. https://doi.org/10.1007/s10620-012-2439-2.

    Article  PubMed  Google Scholar 

  7. Ramesh J, Uk F, Bang JY, et al. Randomized trial comparing the flexible 19G and 25G needles for endoscopic ultrasound-guided fine needle aspiration of solid pancreatic mass lesions. Pancreas. 2015;44:128–33. https://doi.org/10.1097/MPA.0000000000000217.

    Article  PubMed  Google Scholar 

  8. Yang MJ, Yim H, Hwang JC, et al. Endoscopic ultrasound-guided sampling of solid pancreatic masses: 22-gauge aspiration versus 25-gauge biopsy needles. BMC Gastroenterol. 2015;15:122. https://doi.org/10.1186/s12876-015-0352-9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bang JY, Hawes R, Varadarajulu S. A meta-analysis comparing ProCore and standard fine-needle aspiration needles for endoscopic ultrasound-guided tissue acquisition. Endoscopy. 2016;48:339–49. https://doi.org/10.1055/s-0034-1393354.

    Article  PubMed  Google Scholar 

  10. Dwyer J, Pantanowitz L, Ohori NP, et al. Endoscopic ultrasound-guided FNA and ProCore biopsy in sampling pancreatic and intra-abdominal masses. Cancer Cytopathol. 2016;124:110–21. https://doi.org/10.1002/cncy.21623.

    Article  PubMed  Google Scholar 

  11. Jovani M, Abidi WM, Lee LS. Novel fork-tip needles versus standard needles for EUS-guided tissue acquisition from solid masses of the upper GI tract: a matched cohort study. Scand J Gastroenterol. 2017;52:784–7. https://doi.org/10.1080/00365521.2017.1306879.

    Article  CAS  PubMed  Google Scholar 

  12. Shakhatreh MH, Naini SR, Brijbassie AA, et al. Use of a novel through-the-needle biopsy forceps in endoscopic ultrasound. Endosc Int Open. 2016;4:E439–42. https://doi.org/10.1055/s-0042-101941.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Zhang M, Arpin R, Brugge W, Forcione D, Omer Basar MP. Moray™ micro-forceps biopsy improves the diagnosis of specific pancreatic cysts. JASC. 2017;6:S81.

    Google Scholar 

  14. Banafea O, Mghanga FP, Zhao J, et al. Endoscopic ultrasonography with fine-needle aspiration for histological diagnosis of solid pancreatic masses: a meta-analysis of diagnostic accuracy studies. BMC Gastroenterol. 2016;16:1–11. https://doi.org/10.1186/s12876-016-0519-z.

    Article  Google Scholar 

  15. Wang QX, **ao J, Orange M, et al. EUS-guided FNA for diagnosis of pancreatic cystic lesions: a meta-analysis. Cell Physiol Biochem. 2015;36:1197–209. https://doi.org/10.1159/000430290.

    Article  CAS  PubMed  Google Scholar 

  16. Hébert-Magee S, Bae S, Varadarajulu S, et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. Cytopathology. 2013;24:159–71. https://doi.org/10.1111/cyt.12071.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Khan MA, Grimm IS, Ali B, et al. A meta-analysis of endoscopic ultrasound – fine-needle aspiration compared to endoscopic ultrasound – fine-needle biopsy: diagnostic yield and the value of onsite cytopathological assessment Authors. Endosc Int Open. 2017;5:363–75.

    Article  Google Scholar 

  18. Pitman MB. Pancreatic cyst fluid triage: a critical component of the preoperative evaluation of pancreatic cysts. Cancer Cytopathol. 2013;121:57–60. https://doi.org/10.1002/cncy.21227.

    Article  PubMed  Google Scholar 

  19. Balassanian R, Wool GD, Ono JC, et al. A superior method for cell block preparation for fine-needle aspiration biopsies. Cancer Cytopathol. 2016;124:508–18. https://doi.org/10.1002/cncy.21722.

    Article  CAS  PubMed  Google Scholar 

  20. Scarlett CJ, Salisbury EL, Biankin AV, Kench J. Precursor lesions in pancreatic cancer: morphological and molecular pathology. Pathology. 2011;43:183–200. https://doi.org/10.1097/PAT.0b013e3283445e3a.

    Article  PubMed  Google Scholar 

  21. Rosenbaum MW, Jones M, Dudley JC, et al. Next-generation sequencing adds value to the preoperative diagnosis of pancreatic cysts. Cancer Cytopathol. 2017;125:41–7. https://doi.org/10.1002/cncy.21775.

    Article  CAS  PubMed  Google Scholar 

  22. Chai SM, Herba K, Kumarasinghe MP, et al. Optimizing the multimodal approach to pancreatic cyst fluid diagnosis develo** a volume-based triage protocol. Cancer Cytopathol. 2013;121:86–100. https://doi.org/10.1002/cncy.21226.

    Article  CAS  PubMed  Google Scholar 

  23. Cizginer S, Turner BG, Turner B, et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas. 2011;40:1024–8. https://doi.org/10.1097/MPA.0b013e31821bd62f.

    Article  CAS  PubMed  Google Scholar 

  24. Jones M, Zheng Z, Wang J, et al. Impact of next-generation sequencing on the clinical diagnosis of pancreatic cysts. Gastrointest Endosc. 2016;83:140–8. https://doi.org/10.1016/j.gie.2015.06.047.

    Article  PubMed  Google Scholar 

  25. Scourtas A, Dudley JC, Brugge WR, et al. Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms. Cancer Cytopathol. 2017;125:169–77. https://doi.org/10.1002/cncy.21806.

    Article  CAS  PubMed  Google Scholar 

  26. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126:1330–6. https://doi.org/10.1053/j.gastro.2004.02.013.

    Article  PubMed  Google Scholar 

  27. Porte RJ, van der Waaij LA, van Dullemen HM. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc. 2005;62:383–9.

    Article  Google Scholar 

  28. Yoon WJ, Daglilar ES, Pitman MB, Brugge WR. Cystic pancreatic neuroendocrine tumors: endoscopic ultrasound and fine-needle aspiration characteristics. Endoscopy. 2013;45:189–94. https://doi.org/10.1055/s-0032-1325990.

    Article  CAS  PubMed  Google Scholar 

  29. Morales-Oyarvide V, Yoon WJ, Ingkakul T, et al. Cystic pancreatic neuroendocrine tumors; the value of cytology in preoperative diagnosis. Cancer Cytopathol. 2014;122:435–44. https://doi.org/10.1002/cncy.21403.

    Article  CAS  PubMed  Google Scholar 

  30. Raval JS, Zeh HJ, Moser AJ, et al. Pancreatic lymphoepithelial cysts express CEA and can contain mucous cells: potential pitfalls in the preoperative diagnosis. Mod Pathol. 2010;23:1467–76. https://doi.org/10.1038/modpathol.2010.144.

    Article  CAS  PubMed  Google Scholar 

  31. Wu J, Matthaei H, Maitra A, et al. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med. 2011;3:92ra66–92ra66. https://doi.org/10.1126/scitranslmed.3002543.

    Article  CAS  Google Scholar 

  32. Conner JR, Mariño-Enríquez A, Mino-Kenudson M, et al. Genomic characterization of low- and high-grade pancreatic mucinous cystic neoplasms reveals recurrent KRAS alterations in ‘high-risk’ lesions. Pancreas. 2017;46:1. https://doi.org/10.1097/MPA.0000000000000805.

    Article  CAS  Google Scholar 

  33. Pitman MB, Centeno BA, Ali SZ, Genevay M, Stelow E, Mino-Kenudson M, et al. Standardized terminology and nomenclature for pancreatobiliary cytology: the papanicolaou society of cytopathology guidelines. Diagn Cytopathol. 2014;42:338–50.

    Article  Google Scholar 

  34. Pitman MB, Layfield LJ. The papanicolaou society of cytopathology system for reporting pancreaticobiliary cytology. Heidelberg: Springer; 2015.

    Book  Google Scholar 

  35. Nagle JA, Wilbur DC, Pitman MB. Cytomorphology of gastric and duodenal epithelium and reactivity to B72.3: a baseline for comparison to pancreatic lesions aspirated by EUS-FNAB. Diagn Cytopathol. 2005;33:381–6. https://doi.org/10.1002/dc.20343.

    Article  PubMed  Google Scholar 

  36. Stelow EB, Bardales RH, Lai R, et al. The cytological spectrum of chronic pancreatitis. Diagn Cytopathol. 2005;32:65–9. https://doi.org/10.1002/dc.20160.

    Article  PubMed  Google Scholar 

  37. Jarboe EA, Layfield L. Cytologic features of pancreatic intraepithelial neoplasia and pancreatitis: potential pitfalls in the diagnosis of pancreatic ductal carcinoma. Diagn Cytopathol. 2010;39:575–81.

    Article  Google Scholar 

  38. Zhang L, Chari S, Smyrk TC, Deshpande V, Klöppel G, Kojima M, et al. Autoimmune pancreatitis (AIP) type 1 and type 2: an international consensus study on histopathologic diagnostic criteria. Pancreas. 2011;40:1172–9.

    Article  CAS  Google Scholar 

  39. Hong S-M, Park JY, Hruban RH, Goggins M. Molecular signatures of pancreatic cancer. Arch Pathol Lab Med. 2011;135:716–27. https://doi.org/10.1043/2010-0566-RA.1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Deshpande V, Mino-Kenudson M, Brugge WR, et al. Endoscopic ultrasound guided fine needle aspiration biopsy of autoimmune pancreatitis: diagnostic criteria and pitfalls. Am J Surg Pathol. 2005;29:1464–71.

    Article  Google Scholar 

  41. Holmes B.J·, Hruban R.H., Wolfgang C.L. Ali SZ (2012) Fine needle aspirate of autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis): cytomorphologic characteristics and clinical correlates. Acta Cytol 56:228–232. https://doi-org.ezp-prod1.hul.harvard.edu/10.1159/000336135.

    Article  Google Scholar 

  42. Hwang HS, Lee SS, Kim SC, et al. Intrapancreatic accessory spleen: clinicopathologic analysis of 12 cases. Pancreas. 2011;40:956–65. https://doi.org/10.1097/MPA.0b013e318216815b.

    Article  PubMed  Google Scholar 

  43. Kapur U, Wojcik EM. Intrapancreatic accessory spleen: mimic of pancreatic endocrine tumor diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy. Diagn Cytopathol. 2008;36:262–5.

    Article  Google Scholar 

  44. Adsay NV, Hasteh F, Cheng JD, et al. Lymphoepithelial cysts of the pancreas: a report of 12 cases and a review of the literature. Mod Pathol. 2002;15:492–501. https://doi.org/10.1038/modpathol.3880553.

    Article  PubMed  Google Scholar 

  45. Kim YH, Saini S, Sahani D, et al. Imaging diagnosis of cystic pancreatic lesions: pseudocyst versus nonpseudocyst. Radiographics. 2005;25:671–85. https://doi.org/10.1148/rg.253045104.

    Article  PubMed  Google Scholar 

  46. Gonzalez Obeso E, Murphy E, Brugge W, Deshpande V. Pseudocyst of the pancreas. Cancer Cytopathol. 2009;117:101–7. https://doi.org/10.1002/cncy.20000.

    Article  Google Scholar 

  47. Menges M, Lerch MM, Zeitz M. The double duct sign in patients with malignant and benign pancreatic lesions. Gastrointest Endosc. 2000;52:74–7. https://doi.org/10.1067/mge.2000.105775.

    Article  CAS  PubMed  Google Scholar 

  48. Hruban RH, Pitman MB, Klimstra D. Tumors of the pancreas. Atlas of tumor pathology, 4th series, fascicle 6. Washington, DC: Armed Forces Institutes of Pathology; 2007.

    Google Scholar 

  49. Rahemtullah A, Misdraji J, Pitman MB. Adenosquamous carcinoma of the pancreas: cytologic features in 14 cases. Cancer. 2003;99:372–8. https://doi.org/10.1002/cncr.11855.

    Article  PubMed  Google Scholar 

  50. Molberg KH, Heffess C, Delgado R, Albores-Saavedra J. Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas and periampullary region. Cancer. 1998;82:1279–87. https://doi.org/10.1002/(SICI)1097-0142(19980401)82:7<1279::AID-CNCR10>3.0.CO;2-3.

    Article  CAS  PubMed  Google Scholar 

  51. Reid MD, Muraki T, HooKim K, et al. Cytologic features and clinical implications of undifferentiated carcinoma with osteoclastic giant cells of the pancreas: an analysis of 15 cases. Cancer Cytopathol. 2017;125:563–75. https://doi.org/10.1002/cncy.21859.

    Article  CAS  PubMed  Google Scholar 

  52. Layfield LJBJ. Giant-cell containing neoplasms of the pancreas: an aspiration cytology study. Diagn Cytopathol. 2008;36:238–44.

    Article  Google Scholar 

  53. Centeno BA, S E, P M. Pancreas cytohistology. Cytohistology of small tissue samples. Cambridge, UK: Cambridge University Press; 2015.

    Google Scholar 

  54. Collins BT, Cramer HM. Fine-needle aspiration cytology of islet cell tumors. Diagn Cytopathol. 1996;15:37–45. https://doi.org/10.1002/(SICI)1097-0339(199607)15:1<37::AID-DC8>3.0.CO;2-N.

    Article  CAS  PubMed  Google Scholar 

  55. Chen S, Lin J, Wang X, et al. EUS-guided FNA cytology of pancreatic neuroendocrine tumour (PanNET): a retrospective study of 132 cases over an 18-year period in a single institution. Cytopathology. 2014;25:396–403. https://doi.org/10.1111/cyt.12137.

    Article  CAS  PubMed  Google Scholar 

  56. Díaz del Arco C, Díaz Pérez JÁ, Ortega Medina L, et al. Reliability of Ki-67 determination in FNA samples for grading pancreatic neuroendocrine tumors. Endocr Pathol. 2016;27:276–83. https://doi.org/10.1007/s12022-016-9455-2.

    Article  CAS  PubMed  Google Scholar 

  57. Hosoda W, Sasaki E, Murakami Y, et al. BCL10 as a useful marker for pancreatic acinar cell carcinoma, especially using endoscopic ultrasound cytology specimens. Pathol Int. 2013;63:176–82. https://doi.org/10.1111/pin.12045.

    Article  CAS  PubMed  Google Scholar 

  58. Klimstra DS, Wenig BM, Adair CF, Heffess CS. Pancreatoblastoma. A clinicopathologic study and review of the literature. Am J Surg Pathol. 1995;19:1371–89.

    Article  CAS  Google Scholar 

  59. Jutric Z, Rozenfeld Y, Grendar J, et al. Analysis of 340 patients with solid pseudopapillary tumors of the pancreas: a closer look at patients with metastatic disease. Ann Surg Oncol. 2017;24:2015–22. https://doi.org/10.1245/s10434-017-5772-z.

    Article  PubMed  Google Scholar 

  60. Bal MM, Deodhar K, Shrikhande S, Shukla P, Arya SRM. Solid pseudopapillary tumor of the pancreas: “Experiences” and “Lessons” at a tertiary-care oncology center. Diagn Cytopathol. 2012;41:599–606.

    Article  Google Scholar 

  61. Bardales RH, Centeno B, Mallery JS, et al. Endoscopic ultrasound–guided fine-needle aspiration cytology diagnosis of solid-pseudopapillary tumor of the pancreas. Am J Clin Pathol. 2004;121:654–62. https://doi.org/10.1309/DKK2B9V4N0W26A8Q.

    Article  PubMed  Google Scholar 

  62. Brudgge WR, Lauwers GY, Sahani D, et al. Cystic neoplasms of the pancreas. N Engl J Med. 2004;351:1218–26.

    Article  Google Scholar 

  63. Pitman MB, Genevay M, Yaeger K, et al. High-grade atypical epithelial cells in pancreatic mucinous cysts are a more accurate predictor of malignancy than “positive” cytology. Cancer Cytopathol. 2010;118:434–40. https://doi.org/10.1002/cncy.20118.

    Article  PubMed  Google Scholar 

  64. Belsley NA, Pitman MB, Lauwers GY, et al. Serous cystadenoma of the pancreas: limitations and pitfalls of endoscopic ultrasound-guided fine-needle aspiration biopsy. Cancer. 2008;114:102–10. https://doi.org/10.1002/cncr.23346.

    Article  PubMed  Google Scholar 

  65. Adsay NV, Fukushima N, Furukawa T, Hruban RH, Klimstra DSKG. Intraductal neoplasms of the pancreas. In: WHO classification of tumours of the digestive system. Lyon: International Agency for Research on Cancer Press; 2010. p. 304–13.

    Google Scholar 

  66. Kallen ME, Naini BV. Intraductal oncocytic papillary neoplasms of the pancreas. Arch Pathol Lab Med. 2016;140:992–6. https://doi.org/10.5858/arpa.2014-0595-RS.

    Article  CAS  PubMed  Google Scholar 

  67. Pitman MB, Centeno BA, Daglilar ES, et al. Cytological criteria of high-grade epithelial atypia in the cyst fluid of pancreatic intraductal papillary mucinous neoplasms. Cancer Cytopathol. 2014;122:40–7. https://doi.org/10.1002/cncy.21344.

    Article  PubMed  Google Scholar 

  68. Pitman MB, Centeno BA, Genevay M, et al. Grading epithelial atypia in endoscopic ultrasound-guided fine-needle aspiration of intraductal papillary mucinous neoplasms: an international interobserver concordance study. Cancer Cytopathol. 2013;121:729–36. https://doi.org/10.1002/cncy.21334.

    Article  PubMed  Google Scholar 

  69. Tanaka M, Fernández-Del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97. https://doi.org/10.1016/j.pan.2012.04.004.

    Article  PubMed  Google Scholar 

  70. Alzahrani MA, Schmulewitz N, Grewal S, et al. Metastases to the pancreas: the experience of a high volume center and a review of the literature. J Surg Oncol. 2012;105:156–61. https://doi.org/10.1002/jso.22009.

    Article  PubMed  Google Scholar 

  71. DeWitt J, Jowell P, LeBlanc J, et al. EUS-guided FNA of pancreatic metastases: a multicenter experience. Gastrointest Endosc. 2005;61:689–96. https://doi.org/10.1016/S0016-5107(05)00287-7.

    Article  PubMed  Google Scholar 

  72. Volmar KE, Jones CK, **e HB. Metastases in the pancreas from nonhematologic neoplasms: report of 20 cases evaluated by fine-needle aspiration. Diagn Cytopathol. 2004;31:216–20. https://doi.org/10.1002/dc.20100.

    Article  PubMed  Google Scholar 

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  1. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA

    Matthew W. Rosenbaum & Martha B. Pitman

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  1. Department of Pathology, Skåne University Hospital, Lund, Sweden

    Henryk A. Domanski

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Rosenbaum, M.W., Pitman, M.B. (2019). Pancreas. In: Domanski, H. (eds) Atlas of Fine Needle Aspiration Cytology. Springer, Cham. https://doi.org/10.1007/978-3-319-76980-6_12

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