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EUS-FNA of the pancreas

Friday 10 June 2016

EUS-guided FNA for pancreatic cysts; Endoscopic Ultrasound (EUS)/Fine Needle Aspiration (FNA); pancreatic FNA

Images

- Neuroendocrine tumor of pancreas (EUS-FNA). Pap and MG stain.

- solid pseudopapillary neoplasm : papillary structures, discohesive cells, nuclear beta-catenin

- mucinous neoplasm of the pancreas

- IPMN vs MCN +/-atypia

- EUS-FNA of IPMN / intraductal papillary mucinous neoplasm

- solid tumor metastases to the pancreas

- well differentiated pancreatic adenocarcinoma

- pancreatic cyst FNA

- pancreatic adenocarcinoma

Videos

- EUS FNA case - uncinate pancreas, S Varadarajulu, MD

Pancreatic FNA

- mucinous cystadenocarcinoma

  • The cells are large, disorganized, hyperchromatic, pleomorphic, cohesive and have prominent nucleoli.
  • Some also have large vacuoles and have a columnar to cuboidal appearance.
  • Mucinous cystadenocarcinoma of the pancreas shows malignant features on cytology and mucin production.

- mucinous cystic neoplasm MCN

  • MCNs are more likely in the tail and the cells are columnar.
  • MCNs also have an ER positive ovarian stroma that may be seen.
  • The fluid has elevated CEA and CA15-3

- intraductal papillary mucinous neoplasm IPMN

  • IPMN is most likely in the pancreatic head, sometimes the body, and less frequently the tail.
  • IPMN connects to the pancreatic duct system.
  • IPMN may extravasate mucin into the ducts.
  • IPMNs have columnar cells in a papillary configuration.

- microcystic serous cystadenoma

  • Serous cystadenomas usually form at the pancreatic head.
  • They have a female predilection.
  • They are associated with von Hippel Lindau syndrome.
  • Serous neoplasms are usually cuboidal, mucinous are more likely columnar.

- pancreatic endocrine tumor
- * Pancreatic endocrine neoplasms have a salt and pepper chromatin pattern.

  • They are divided into two types: pancreatic endocrine tumors, and pancreatic endocrine carcinomas.
  • Pancreatic endocrine tumors are classified as grade 1 or 2. Grade 1 have a Ki-67 @<@ 3% and no more 1 mitotic figure per 10 HPFs. Grade 2 have a Ki-67 of 3-20% or a mitotic count of 2-20. Any more than this qualifies as carcinoma.
  • Pancreatic endocrine carcinomas are divided into small or large cell.

Open references

- Management of branch-duct intraductal papillary mucinous neoplasms. 2016.
http://www.giejournal.org/article/S0016-5107(16)00158-9/fulltext

References

- American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data. Singhi AD, Zeh HJ, Brand RE, Nikiforova MN, Chennat JS, Fasanella KE, Khalid A, Papachristou GI, Slivka A, Hogg M, Lee KK, Tsung A, Zureikat AH, McGrath K. Gastrointest Endosc. 2016 Jun;83(6):1107-1117.e2. doi : 10.1016/j.gie.2015.12.009 PMID: 26709110

- Diagnostic error assessment and associated harm of endoscopic ultrasound-guided fine-needle aspiration of neuroendocrine neoplasms of the pancreas. 2013. http://onlinelibrary.wiley.com/enhanced/doi/10.1002/cncy.21332/