Cytopathology of Inflammatory Lesions of the Pancreatobiliary Tree

Abstract

Context.— A variety of inflammatory processes affect the pancreatobiliary tree. Some form mass lesions in the pancreas, mimicking pancreatic ductal adenocarcinoma, and others cause strictures in the bile ducts, mimicking cholangiocarcinoma. Acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, and paraduodenal groove pancreatitis have distinct cytopathologic features that, when correlated with clinical and imaging features, may lead to correct classification preoperatively. In biliary strictures sampled by endobiliary brushing, the uniform features are the variable presence of inflammation and reactive ductal atypia. A potential pitfall in the interpretation of pancreatobiliary fine-needle aspiration and duct brushing specimens is ductal atypia induced by the reactive process. Recognizing cytologic criteria that differentiate reactive from malignant epithelium, using ancillary testing, and correlating these features with clinical and imaging findings can lead to the correct preoperative diagnosis. Objective.— To summarize the cytomorphologic features of inflammatory processes in the pancreas, describe the cytomorphology of atypia in pancreatobiliary specimens, and review ancillary studies applicable for the differential diagnosis of benign from malignant ductal processes for the purpose of best pathology practice. Data Sources.— A PubMed review was performed. Conclusions.— Accurate preoperative diagnosis of benign and malignant processes in the pancreatobiliary tract can be achieved with application of diagnostic cytomorphologic criteria and correlation of ancillary studies with clinical and imaging findings.