Acinar cell cystadenoma: A challenging cytology diagnosis, facilitated by moray^® micro‐forceps biopsy

Abstract

Acinar cell cystadenoma is a rare, benign cystic lesion of the pancreas. There have been only a few retrospective reports on its cytological features. We present the first case of acinar cell cystadenoma in a 65-year-old woman, diagnosed pre-operatively by pancreatic cyst fluid cytology and Moray micro-forceps biopsy. We emphasize possible diagnostic pitfalls of acinar cell cystadenoma cyst fluid cytology and suggest useful morphologic, immunohistochemical, and other clues to aid in diagnosis. Diagn. Cytopathol. 2017;45:557-560. © 2017 Wiley Periodicals, Inc.

Moray micro forceps biopsy improves the diagnosis of specific pancreatic cysts

“…However, 3 times as many IPMNs, 1 MCN (Fig. ), and 1 acinar cell cystadenoma were diagnosed by MFB alone.…”

Cystic Lesions of the Pancreas: Differential Diagnosis and Cytologic-Histologic Correlation

“…Amorphous debris (Figure 13, C) resembling mucin can be seen and should not be interpreted as mucinous neoplasm. 105 On histologic examination, acinar cystadenoma is composed of a cystic lesion with single or multiple cell layers. The cell lining consists of bland, low cuboidal to columnar cells (Figure 13, D), with apical eosinophilic zymogen granules that can be highlighted with periodic acid-Schiff stain with diastase pretreatment (Figure 13, D, inset).…”

Risk of malignancy in pancreatic cysts with cytology of high‐grade epithelial atypia

“…The pancreatic cyst fluid CEA level was 1.2 ng/mL. Three months later, repeat EUS‐FNA with concurrent Moray microforceps biopsy of the growing cyst was diagnostic of acinar cell cystadenoma . Immunoreactivity for trypsin and chymotrypsin, nonimmunoreactivity for synaptophysin, and a low Ki‐67 index supported the diagnosis.…”

“…16,17 The discordance between the low-risk imaging, the high-grade cytology, and the relatively young age of the patient led to repeat sampling with the microforceps biopsy, which provided a small histological sample that allowed for immunohistochemical confirmation of the diagnosis. 10 As described by Pitman et al, 9 there are several challenges in the cytologic grading of pancreatic cyst fluid. The variety of neoplastic cell types and the varying degrees of reactive atypia and degeneration displayed contribute to the difficulty in cytologic interpretation.…”

“…The small cells with a high nuclear‐to‐cytoplasmic ratio of acinar cell cystadenomas fit the criteria for high‐grade atypia . The discordance between the low‐risk imaging, the high‐grade cytology, and the relatively young age of the patient led to repeat sampling with the microforceps biopsy, which provided a small histological sample that allowed for immunohistochemical confirmation of the diagnosis …”