Retroperitoneal Bronchogenic Cyst as a Differential Diagnosis of Pancreatic Mucinous Cystic Tumor

Andersson, Roland; Lindell, Gert; Cwikiel, Wojciech; Dawiskiba, Sigmund

doi:10.1159/000068851

Cited by 17 publications

(9 citation statements)

References 15 publications

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“…224 They may have respiratory (bronchogenic) or simple ciliated epithelium. [225][226][227] We have also seen two examples with ciliated epithelium. One of these contained inner and outer muscular coats typical of intestinal wall, and had an associated high-grade papillary adenocarcinoma with pancreatobiliary-type features.…”

Section: Cystic Hamartomasmentioning

confidence: 77%

Cystic lesions of the pancreas

Adsay

2007

Modern Pathology

188

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Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Advances in imaging and interventional techniques and the sharp drop in the mortality rate of pancreatic surgery have rendered pancreatic biopsies and resections commonplace specimens. Consequently, in the past two decades, the nature of many cystic tumors in this organ has been better characterized. The names of some existing entities were revised; for example, what was known as papillary-cystic tumor is now regarded as solidpseudopapillary tumor. New entities, in particular, intraductal papillary mucinous neoplasm and its variants, such as oncocytic and intestinal subtypes were recognized. The importance of clinical and pathologic correlation in the evaluation of these lesions was appreciated, in particular, with regards to the multifocality of these lesions, their association with invasive carcinomas, and thus their 'preinvasive' nature. Consensus criteria for the distinction of these from the ordinary precursors of adenocarcinoma, the pancreatic intraepithelial neoplasia, were established. The definition of mucinous cystic neoplasms was refined; ovarian-like stroma has now become almost a requirement for the diagnosis of mucinous cystic neoplasia, and defined as such, the propensity of these tumors to occur in perimenopausal women became even more striking. The validity and clinical value of classifying the pancreatic cysts of mucinous type as adenoma, borderline, CIS and invasive have been established. Related to this, the importance of thorough sampling in accurate classification of these mucinous lesions was recognized. Greater accessibility of the pancreas afforded by improved invasive as well as noninvasive modalities has also increased the detection of otherwise clinically silent cystic tumors, which has led to the recognition of more innocuous entities such as acinar cell cystadenoma and squamoid cyst of pancreatic ducts. As the significance of the cystic lesions emerged, cystic forms of otherwise typically solid tumors were also better characterized. Thus, significant developments have taken place in the classification and our understanding of pancreatic cystic tumors in the past few years, and experience with these lesions is likely to grow exponentially in the coming years. Modern Pathology (2007) 20, S71-S93.

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Section: Cystic Hamartomasmentioning

confidence: 77%

Cystic lesions of the pancreas

Adsay

2007

Modern Pathology

188

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“…However, these cysts are frequently misdiagnosed as pancreatic, cystic mucinous neoplasms that can lead to inappropriate surgical intervention. [1213] There is an isolated report describing the EUS-FNA findings of a ciliated foregut cyst of pancreas evaluated retrospectively after surgicallyresection. [9] To our knowledge, this is the first case of a pancreatic ciliated foregut cyst diagnosed preoperatively by EUS-FNA.…”

Section: Discussionmentioning

confidence: 99%

“…[9] A 4.5 cm, retroperitoneal bronchogenic cyst, in a 38-year-old man is reported. [12] This cyst was attached to but was separate from the pancreas. Cytological preparations of EUS-FNA showed cuboidal-to-low-columnar epithelium, and a pancreatic mucinous cystic tumor was suggested leading to surgical resection.…”

Section: Discussionmentioning

confidence: 99%

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Ciliated foregut cyst of the pancreas: Preoperative diagnosis using endoscopic ultrasound guided fine needle aspiration cytology—A case report with a review of the literature

et al. 2009

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A 51-year-old male presented with a 4-month history of abdominal pain, decreased appetite, and postprandial bloating. A CT scan showed a solitary, 5.3 × 4.4 cm, cystic lesion in the body/tail of the pancreas. Endoscopic retrograde cholangiopancreatography did not show communication between the pancreatic duct and the cystic lesion. Endoscopic ultrasound (EUS) examination revealed a 6.9 × 2.4 cm cystic lesion in the body/tail region of the pancreas without septae or solid components. The pancreatic parenchyma, pancreatic duct, and common bile duct were unremarkable. EUS-guided fine needle aspiration (EUS-FNA) was performed using a 22-gauge EchotipTM needle. Only a few drops of viscous fluid could be aspirated. Papanicolaou-stained direct smears and SurePath (Autocyte) preparations were evaluated. The direct smears were hypocellular; however, the concentration method producing liquid-based cytology preparation showed detached ciliary tufts (degenerated debris with ciliated cellular fragments of cell tops without nuclei) and occasional intact ciliated cells consistent with a ciliated foregut cyst. Although benign, the cyst was resected to alleviate the symptoms. The surgical pathology confirmed the benign preoperative interpretation of the ciliated foregut cyst. To the best of our knowledge, this is the first case of pancreatic ciliated foregut cyst reported to be diagnosed preoperatively by EUS-FNA. For a proper preoperative cytologic diagnosis, the needle rinses should be processed adequately. Otherwise, these hypocellular specimens with mucin may be misinterpreted as mucinous cystic lesions.

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“…La biopsia percutánea con aguja fina es considerada un procedimiento seguro en general, pero en estos casos tiene el potencial riesgo de sembrar células malignas, además de los riesgos inherentes al procedimiento; y con la posibilidad de entregar resultados falsos positivos y negativos 14 .…”

Section: Tabla 2 Diagnóstico Diferencial Y Características En La Tacunclassified