Large, clear cytoplasmic vacuolation

Abstract

BACKGROUND. Solid pseudopapillary neoplasm (SPN) and pancreatic endocrine neoplasm (PEN) are uncommon neoplasms that demonstrate characteristic cytologic features. It is also known that both these tumors may share similar morphologic changes. These features not uncommonly pose significant diagnostic challenge for unsuspecting cytopathologists. In the current study, the authors report that recognition of clear cytoplasmic vacuoles in endoscopic ultrasound–guided fine–needle aspiration (EUS‐FNA) samples from SPN serves as a useful clue that can distinguish this tumor from PEN. METHODS. The cytologic features from 5 SPN and 20 PEN cases were evaluated. Both Diff‐Quik and Papanicolaou stains from these cases were examined. A Fisher exact test of probability was performed to determine differences in the individual cytologic features noted in these 2 tumor types. RESULTS. The results demonstrated that pseudopapillary groups (P = .004); metachromatic matrix material (P = .004); nuclear membrane irregularity (P = .004); and large, clear cytoplasmic vacuoles (P = .001) are noted significantly more frequently in SPN. The authors also demonstrated that large, clear cytoplasmic vacuoles can serve as a powerful cytologic clue for the suspicion of SPN over PEN when there is a paucity of papillary groups within the smears. Large, clear cytoplasmic vacuoles, however, were noted only in Diff‐Quik–stained smears, but not in Papanicolaou‐;stained smears. CONCLUSIONS. The results of the current study highlight that large, clear cytoplasmic vacuoles can serve as a critical clue with which to distinguish SPN from PEN in diagnostically challenging cases. Cancer (Cancer Cytopathol) 2008. © 2008 American Cancer Society.

Solid Pseudopapillary Neoplasms of the Pancreas: A Report of Two Cases

“…Preoperative histologic confirmation is not necessary and is usually reserved for patients who have high operative risk or who require complex resections (borderline-resectable tumor, vascular resection required, and/or nodal disease outside of the resection margins). In these cases, image guided fine needle aspiration cytology may make the diagnosis preoperatively with 62–70% overall accuracy [11, 12, 17]. The lesion is comprised of small ovoid or polygonal cells with small central nuclei and abundant cytoplasm [17, 18].…”

“…In these cases, image guided fine needle aspiration cytology may make the diagnosis preoperatively with 62–70% overall accuracy [11, 12, 17]. The lesion is comprised of small ovoid or polygonal cells with small central nuclei and abundant cytoplasm [17, 18]. Histologic markers of poor prognosis include a high mitotic rate, spindling of tumor cells, anaplastic giant cells, capsular invasion, and lympho-vascular involvement [17–20].…”

“…The lesion is comprised of small ovoid or polygonal cells with small central nuclei and abundant cytoplasm [17, 18]. Histologic markers of poor prognosis include a high mitotic rate, spindling of tumor cells, anaplastic giant cells, capsular invasion, and lympho-vascular involvement [17–20]. …”

Clear cell variant of solid pseudopapillary neoplasm of pancreas diagnosed by fine needle aspiration: A case report and review of the literature

“…Jhala et al ., were first to report the cytologic features of the clear cell variant of SPN in 2007,[7] In a subsequent paper Jhala et al ., compared the cytoplasmic vacuoles in pancreatic endocrine tumor (PEN) and SPN. [3] They concluded that the presence of large clear vacuoles was more in favor of SPN than PEN. Hav et al ., and Tanino et al ., reported one case each of this entity.…”

“…[134567] We present the cytologic features of clear cell variant of SPN with the broad differential diagnosis and a review of past studies.…”