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pancreatobiliary tract cytology

Friday 27 May 2016

Practical Tips in Cytology of the Liver and Pancreatobiliary System for the Surgical Pathologist (Martha Bishop Pitman, M.D.)

1. A liver FNA that produces "dirty necrosis" is metastatic colon cancer until proven otherwise.
2. Clusters of hepatocytes surrounded by endothelial cells are malignant.
3. Malignant cells wrapped by endothelial cells are hepatocellular carcinoma
4. Cell blocks and/or core biopsy with FNA is more accurate than either alone for diagnosis of liver masses.
5. Bile duct brushing cytology is HARD, so have a high threshold for malignancy.
6. Pancreatic ductal cells with cytoplasmic mucin are pathologic.
7. A sea of monomorphic tumor cells is most likely pancreatic neuroendocrine tumor (PanNET) and not a pancreatic ductal adenocarcinoma (PDAC).
8. Acellular thick, colloid-like mucin from a pancreatic cyst is NOT non-diagnostic.
9. CEA analysis of pancreatic cyst fluid is the best test for determining a mucinous cyst.
10. High-grade atypical epithelial cells (high-grade atypia) in pancreatic mucinous cyst fluid is a high risk feature for malignancy.

Notes

- Improving the accuracy of pancreatobiliary tract cytology with FISH