Cytoplasmic vacuolization: An under‐recognized cytomorphologic feature in endocrine tumors of the pancreas

Levy, Gillian H.; Finkelstein, D.O. Alexander; Harigopal, Malini; Chhieng, David C.; Cai, Guoping

doi:10.1002/dc.22893

Cited by 17 publications

(13 citation statements)

References 22 publications

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“…In one case, PanNET was cytologically misdiagnosed as adenocarcinoma, for the most part because of the presence of cohesive groups of tumor cells with significant nuclear atypia and anisonucleosis. Although the majority of cases of PanNET demonstrate classic cytologic features, rare cases with significant variation in nuclear size and vacuolated cytoplasm did occur and have been reported in the literature . Under these circumstances, it would be important to obtain sufficient material for a cell block on which immunocytochemical stains with neuroendocrine markers, such as chromogranin and synaptophysin, could be performed to confirm the diagnosis …”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound‐guided pancreatic fine‐needle aspiration: Potential pitfalls in one institution's experience of 1212 procedures

Bergeron

Perry

Houser

et al. 2014

Cancer Cytopathology

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BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has emerged as the diagnostic modality of choice for mass lesions in the pancreas. The objective of the current study was to determine the accuracy and pitfalls of EUS-FNA in the diagnosis of pancreatic lesions in cases that involved follow-up surgical resection. METHODS: Cases of EUS-FNA of pancreatic lesions performed from 2007 to mid-2012 for which subsequent surgical resection was performed were retrieved from the department's database. The accuracy of the cytologic diagnosis was assessed using the histological diagnosis as the gold standard. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. "Neoplastic," "suspicious," and "malignant" were classified as a positive cytologic diagnosis. In one calculation method, "atypical" was also included as a positive cytologic diagnosis whereas in another it was not considered to be a positive cytological result. The cases with a cytologic-histological discrepancy were reviewed to identify sources of errors.RESULTS: A total of 1212 cases from 1104 patients (518 women and 586 men; age range, 18-94 years [average age, 63.5 years]) were identified. Cytologic diagnoses included 52 unsatisfactory, 224 benign, 129 atypical, 140 neoplasm, 35 suspicious, and 632 malignant diagnoses. Of these cases, 397 patients had histological follow-up information available. The sensitivity, specificity, positive predictive value, and negative predictive value were 83.2%, 85.9%, 95.9%, and 56.1%, respectively, with atypical cases excluded from the analysis. When atypical cases were included as a positive cytologic diagnosis, the sensitivity, specificity, positive predictive value, and negative predictive value were 86.7%, 67.9%, 90.7%, and 58.5%, respectively, and were 73.7%, 87.7%, 95.6%, and 48.0%, respectively, when atypical cases were included as a negative cytologic diagnosis. The major difficulty in EUS-FNA cytology was to differentiate pancreatic mucinous neoplasms from contaminants of gastric mucosa. Other pitfalls included differentiating mucinous neoplasm from extensive pancreatic intraepithelial neoplasia, and endocrine tumor from nesidioblastosis versus acinar cell carcinoma or intrapancreatic spleen.CONCLUSIONS: EUS-FNA is a valuable tool for the diagnosis of pancreatic lesions, especially solid malignant tumors.Cytologic-radiological correlation is essential in differentiating pancreatic mucinous neoplasms from gastric mucosa, because the former usually are found to have characteristic features on imaging. Pathologists should be aware of the pitfalls in the cytologic diagnosis of pancreatic lesions that may significantly change the clinical management of the patients.Cancer (Cancer Cytopathol) 2015;123:98-107.

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Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound‐guided pancreatic fine‐needle aspiration: Potential pitfalls in one institution's experience of 1212 procedures

Bergeron

Perry

Houser

et al. 2014

Cancer Cytopathology

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“…In summary, PanNET is an uncommonly diagnosed entity on cytology, and variants are even less frequently encountered. In our review, we identified only one prior case of pigmented PanNET diagnosed by FNA and only seven reports (ten cases) of FNA‐diagnosed clear cell PanNET . Metastases to the pancreas are also infrequently encountered in EUS‐FNA material, being far less common than primary pancreatic tumors .…”

Section: Discussionmentioning

confidence: 99%

Two unusual variants of pancreatic neuroendocrine tumor and their potential pitfalls on fine‐needle aspiration cytology

Richmond

Mehrotra

2017

Diagnostic Cytopathology

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Endoscopic ultrasound-guided fine-needle aspiration is increasingly utilized for the diagnosis of pancreatic lesions. Although operator dependent, the procedure has good overall performance characteristics and is minimally invasive; however, accuracy and sensitivity are reportedly lower for pancreatic neuroendocrine tumor (PanNET) compared with the more common pancreatic ductal adenocarcinoma (pACA). The underperformance is further exacerbated by the unusual cases of PanNET presenting with variant cytomorphology. We report two separate diagnostically challenging cases: a pigmented PanNET and a clear cell PanNET. We briefly review the literature and emphasize the importance of recognizing these uncommon variants when encountered in aspirate material. Diagn. Cytopathol. 2017;45:371-378. © 2016 Wiley Periodicals, Inc.

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“…The cytoplasm usually is moderate in amount and is pale, granular, or amphophilic. Cytoplasmic vacuoles are uncommon and if present, they are not prominent . Due to rich vascularity of neuroendocrine tumors, capillaries that traverse in‐between the tumor cells are not uncommonly seen.…”

Section: Discussionmentioning

confidence: 99%

“…The tumor cells were positive for AE1/AE3, synaptophysin, and chromogranin. Recently, Levy et al reported the presence of cytoplasmic vacuolization as an under‐recognized cytomorphologic feature in PET . The authors reported three cases of PET having small distinct cytoplasmic vacuoles on cytology smears.…”

Section: Discussionmentioning

confidence: 99%

“…Although an adrenal cortical neoplasm can look similar to lipid‐rich PETs, the absence of background lipid droplets is an important clue in the cytological diagnosis of a PET rather than an adrenal cortical neoplasm (Table ). There was no mention of the presence or absence of extracellular lipid droplets in the background in two recent reports . Nevertheless, an IHC panel for keratin, endocrine markers, and inhibin is always helpful to make a definitive diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Cytologic features of lipid‐rich variant of pancreatic endocrine tumor—Report of two cases with literature review

Zhang

Lee

2013

Diagnostic Cytopathology

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Pancreatic endocrine tumor (PET) is an uncommon neoplasm of the pancreas with distinct cytomorphologic features. Lipid-rich PET, a rare variant, histologically deviates from that of a conventional PET. There is only one case report of the cytologic features of this rare entity in the literature. We report two cases of lipid-rich PETs diagnosed by endoscopic ultrasound-guided FNA biopsy. Case 1 showed large aggregates, small clusters, and single cells with plasmacytoid appearance, small uniform nuclei, coarse chromatin, and prominent nucleoli. Abundant distinct small cytoplasmic vacuoles were present in almost all tumor cells and the background was clean. Case 2 showed flat cohesive sheets of medium-sized uniform cells with indistinct plasmacytoid appearance, uniform nuclei, fine and evenly distributed chromatin, and inconspicuous nucleoli. Distinct small cytoplasmic vacuoles were seen only focally. Immunohistochemical stains in cell blocks of both cases confirmed the diagnosis of PET. Lipid-rich PET may be misinterpreted on cytology specimens if the pathologist is not aware of this rare entity since it mimics clear cell carcinoma of the kidney, adrenal cortical neoplasm, or adenocarcinoma of the pancreas.

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Cytoplasmic vacuolization: An under‐recognized cytomorphologic feature in endocrine tumors of the pancreas

Cited by 17 publications

References 22 publications

Endoscopic ultrasound‐guided pancreatic fine‐needle aspiration: Potential pitfalls in one institution's experience of 1212 procedures

Endoscopic ultrasound‐guided pancreatic fine‐needle aspiration: Potential pitfalls in one institution's experience of 1212 procedures

Two unusual variants of pancreatic neuroendocrine tumor and their potential pitfalls on fine‐needle aspiration cytology

Cytologic features of lipid‐rich variant of pancreatic endocrine tumor—Report of two cases with literature review

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