Endoscopic ultrasound‐guided fine needle aspiration with liquid‐based cytology preparation in the diagnosis of metastatic small‐cell carcinoma in the pancreas

Abstract

Pancreatic metastasis is extremely rare, particularly from small‐cell lung cancer (SCLC). Studies on the role of endoscopic ultrasound‐guided fine needle aspiration (EUS‐FNA) with liquid‐based cytology (LBC) in the diagnosis of metastatic small‐cell carcinoma in the pancreas have been rarely conducted. We report herein a case of pancreatic metastasis from SCLC diagnosed using EUS‐FNA with LBC (ThinPrep). A 71‐year‐old man presented with chief complaints of hemoptysis and jaundice over the past 1 month. Lung & pancreas tumors with multiple liver nodules were detected on computed tomography. The aspirated material from the pancreas using EUS‐FNA was prepared as a cytologic specimen with ThinPrep method, which revealed scattered and clustered “small blue cells” with scant cytoplasm and stippled chromatin with frequent apoptotic bodies. Immunocytochemical staining of the cellblock material revealed strong positivity for CD56 and thyroid transcription factor‐1. Endobronchial biopsy for lung mass revealed nests of small, round, blue tumor cells with hyperchromatic nuclei showing salt and pepper chromatin, scant cytoplasm, and brisk mitotic activity. Therefore, a diagnosis of metastatic small‐cell carcinoma to the pancreas with an extensive stage was finally made.

Primary pancreatic cystadenocarcinoma with ovarian metastases in a 38-year-old female: case report

“…PET/CT was also reported to diagnose ovarian metastasis as initial presentation of pancreatic carcinoma ( 11 ). Besides, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is safe in diagnosing solid pancreatic lesions ( 12 , 13 ). It was reported that EUS-FNA with liquid-based cytology could diagnosis the metastatic small-cell carcinoma to the pancreas ( 13 ).…”

“…Besides, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is safe in diagnosing solid pancreatic lesions ( 12 , 13 ). It was reported that EUS-FNA with liquid-based cytology could diagnosis the metastatic small-cell carcinoma to the pancreas ( 13 ). In fact, surgeons and gynecologists tend to only focus on the pancreatic lesion or the ovarian neoplasm respectively, resulting in a missed diagnosis and delayed therapy.…”

The usefulness of liquid-based cytology for endoscopic ultrasound-guided tissue acquisition of solid pancreatic masses

“…Rossi et al reported that primary pancreatic malignant lymphoma was successfully diagnosed using immunostaining of LBC specimens for EUS-TA ( 36 ). Son et al showed that immunostaining for TTF-1 and CD56 could be used to diagnose metastatic pancreatic cancer using LBC specimens from EUS-TA ( 37 ). Thus, in cases in which immunostaining is difficult because of insufficient tissue samples, a detailed diagnosis can be made by immunostaining LBC specimens.…”

Value of contrast-enhanced ultrasound combined with percutaneous ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions

“…The smear cytology (SC) has the problem of cell crowding. A new cytological method named ThinPrep (Hologic Inc., Marlborough, MA, USA) cytologic test (TCT) could overcome the deficiency of SC and result in an accurate diagnosis [5] . In the absence of an on-site cytopathologist, TCT offers good diagnostic efficacy in patients with pancreatic mass lesions [6] .…”

“…A new cytological method named ThinPrep (Hologic Inc., Marlborough, MA, USA) cytologic test (TCT) could overcome the deficiency of SC and result in an accurate diagnosis. [5] In the absence of an on-site cytopathologist, TCT offers good diagnostic efficacy in patients with pancreatic mass lesions. [6] In our study, only the TCT process was included to avoid the impact of methodological differences.…”