Intraductal Papillary-Mucinous Neoplasm of the Pancreas: The Findings and Limitations of Cytologic Samples Obtained by Endoscopic Ultrasound-Guided Fine-Needle Aspiration

Abstract

All clinically and ultrasonographically suspected examples of intraductal papillary-mucinous neoplasm (IPMN) aspirated during a 17-month period were reviewed and analyzed for follow-up. We identified 18 cases of suspected IPMN in patients 52 to 87 years old. All patients had dilated pancreatic ducts, with 3 showing sonographically apparent intraductal papillary lesions; 5 had adjacent cystic or solid pancreatic masses. Cytologic preparations showed thick, glistening, viscid, abnormal mucus in all cases. Aspirates from 13 lesions (72%) were acellular or sparsely cellular, but entrapped single or loosely cohesive neoplastic cells were identified in 16 cases (89%). Goblet cell morphologic features were common (6/18 [33%]), but papillary clusters and dysplastic changes were infrequent (3 [17%] each). In keeping with current therapeutic thinking, confirmatory histologic follow-up was available for only 4 patients (22%), as most people with lesions clinically, sonographically, and cytologically consistent with IPMN are elderly and often have comorbid conditions. Although endoscopic ultrasound-guided fine-needle aspiration has important limitations, gross and cytologic findings can aid in confirming the suspected diagnosis, and integration of complete clinical, sonographic, and cytologic information may be the best way to reach the most accurate diagnosis possible.

The genetic classification of pancreatic neoplasia

“…Additionally, cyst fluid may be evaluated for microRNAs or for mucins. When integrated with clinical findings, such molecular approaches have the potential of fundamentally changing the way cystic neoplasms of the pancreas are managed [120][121][122][123][124].…”

Diagnostic utility of mucin profile in fine-needle aspiration specimens of the pancreas

“…It has proven to be a valuable tool in the preoperative diagnosis and management of patients with pancreatic lesions. [1][2][3][4][5][6] Whereas most aspirations yield diagnostic material, the differential diagnosis of the reactive/reparative and neoplastic processes as well as their precise classification in the pancreatic EUS-FNAs specimens can be challenging. This can be explained by the considerable overlap in the cytomorphologic features of these processes in the pancreas.…”

“…[1][2][3][4][5][6] Ductal adenocarcinoma is the most common malignancy of the pancreas. 7 Recently, it has been shown that the malignant transformation of pancreatic ductal epithelium changes the epithelial expression of apomucins.…”

Endoscopic Ultrasonography in Management of Cystic Disease of the Pancreas

“…What can explain such high specificity and low sensitivity for cytology is that the presence of sticky fluid on aspiration or mucin in cytology is highly diagnostic for mucinous cysts. However, aspirate can be acellular or with minimal cellularity in up to 72% of aspirated cysts [49,50]. FNA is not useful in SCA with diagnostic accuracy of only 17% [51].…”