Endoscopic ultrasound-guided fine needle aspiration cytology of intraductal papillary mucinous tumor of the pancreas. A case report

BACKGROUND: Intraductal papillary mucinous tumor (IPMT) of the pancreas is a recently proposed pancreatic tumor entity with a peculiar clinical and pathologic profile. It presents with symptoms that are mostly attributed to the mass effect of the tumor. However, a long history of diabetes mellitus and/or chronic pancreatitis is usually noted. It is thought that IPMT has better prognosis than the usual pancreatic ductal adenocarcinoma and its early identification is important. On imaging studies these neoplasms appear usually as multiloculated, cystic tumors that cannot be easily differentiated from other cystic pancreatic neoplasms. CASE: A 73-year-old, white woman with recent symptoms related to bile duct obstruction and diabetes mellitus and a long history of "chronic pancreatitis" was found to have a pancreatic mass on computed tomography. Endoscopic ultrasound-guided fine needle aspiration of the pancreatic mass and dilated pancreatic duct was performed. Cytopathologic examination of the aspirated material revealed large cells with abundant, eosinophilic cytoplasm arranged singly or occasionally in large sheets with complex papillary fragments. Occasional goblet cells or cells with cytoplasmic mucin-containing vacuoles were also noted within the tumor tissue fragments. The nuclei were large, with nuclear size variability and prominent nucleoli. Copious amounts of mucin and numerous muciphages were noted in the background. A diagnosis of "cystic mucinous tumor, cannot rule out invasion," was entertained. The patient underwent partial pancreatectomy. The histologic features of the resected specimen were consistent with IPMT, with focal areas suggestive of early stromal invasion. CONCLUSION: The cytologic features encountered in the aspirate of this tumor are highly suggestive of IPMT and can help differentiate it from other pancreatic tumors with mucin production, such as the classic mucinous cystic neoplasm and the more common ductal carcinoma.     

Mucin-hypersecreting bile duct neoplasm characterized by clinicopathological resemblance to intraductal papillary mucinous neoplasm (IPMN) of the pancreas

Background

Ultrasound-guided vacuum-assisted breast biopsy technology is extremely useful for diagnostic biopsy of suspicious breast lesions and for attempted complete excision of appropriately selected presumed benign breast lesions.

Case presentation

A female patient presented with 16 breast lesions (eight within each breast), documented on ultrasound and all presumed to be fibroadenomas. Over a ten and one-half month period of time, 14 of these 16 breast lesions were removed under ultrasound guidance during a total of 11 separate 8-gauge Mammotome^® excision procedures performed during seven separate sessions. Additionally, two of these 16 breast lesions were removed by open surgical excision. A histopathologic diagnosis of fibroadenoma and/or fibroadenomatous changes was confirmed at all lesion excision sites. Interval follow-up ultrasound imaging revealed no evidence of a residual lesion at the site of any of the 16 original breast lesions.

Conclusion

This report describes an innovative approach of utilizing ultrasound-guided 8-gauge vacuum-assisted breast biopsy technology for assisting in achieving complete eradication of multiple bilateral fibroadenomas in a patient who presented with 16 documented breast lesions. As such, this innovative approach is highly recommended in similar appropriately selected patients.     

Diagnosis of the rare solid and papillary epithelial neoplasm of the pancreas by fine needle aspiration cytology. Light and electron microscopic study of a case

A case of the rare solid and cystic papillary tumor of the pancreas in a young woman is described. The diagnosis was made by fine needle aspiration cytology, with electron microscopic examination of the needle washings. The preoperative cytologic diagnosis enabled appropriate surgical treatment to be planned and carried out without undue delay. It is important to distinguish this rare tumor from other pancreatic tumors with similar cytohistologic features since, if diagnosed correctly and managed surgically, this neoplasm is associated with a good prognosis.     

Ascitic fluid cytology in a case of metastatic malignant mixed mesodermal tumor of the ovary

The cytologic features of the abdominal fluid from a patient with a malignant mixed mesodermal tumor (MMMT) of the ovary are presented. Both malignant epithelial and stromal elements were cytologically appreciated and confirmed by histologic examination. Other ovarian neoplasms that can present with malignant sarcomatous elements or mixed epithelial and sarcomatous elements are discussed; this case documents the importance of recognizing these features when staging patients with unusual ovarian neoplasms. To our knowledge, this is the first complete report of the ascitic fluid cytology of an MMMT of either ovarian or uterine origin.     

Fine needle aspiration cytology of an intraductal papilloma originating in a sublingual gland. A case report.

BACKGROUND: Intraductal papilloma of the salivary gland is a very rare tumor; only eight cases have been reported to date. Only histopathology has been used to investigate this tumor to our knowledge. There has not been any reported case of this tumor in a sublingual gland. CASE: A 3-cm oral floor mass with a lanulalike lesion in a 72-year-old female was aspirated. The cytologic features included various cellular smears containing compact clusters of papillary, radial, palisading, trabecular, tubular and buddinglike projected patterns; monomorphic columnar cells with oval-to-spindle nuclei basally located; abundant, finely vacuolar cytoplasm; indistinct nucleoli; and no squamous differentiated cells. A sublingual glandectomy was performed. Cytology, histology, immunohistochemistry and electron microscopy were performed with standard methods. The intraductal papilloma seems to have arisen within an excretory duct and differentiated into acinar cells. CONCLUSION: The cytologic findings of intraductal papilloma are unique and may allow its specific diagnosis on fine needle aspiration.     

Papillary cystic neoplasm of the pancreas. Report of a case diagnosed by fine needle aspiration cytology

Fine needle aspiration (FNA) performed on a young woman who presented with a mass in the left hypochondrium yielded fluid. Smears and Cytospin preparations of the fluid showed good cellularity, consisting of relatively monomorphic cells forming a perivascular papillary pattern. FNA cytology thus suggested a diagnosis of papillary cystic neoplasm of the pancreas. Surgical removal of the pancreatic tumor and detailed histologic study confirmed the cytologic diagnosis.     

Cytology of papillary solid-cystic neoplasm of the pancreas presenting as an extrapancreatic mass: a case report

BACKGROUND: Papillary solid cystic neoplasm (PSCN) of the pancreas is a tumor of low malignant potential and has an excellent prognosis. Although the cytologic features are well documented, it can pose a diagnostic problem when it presents as an extrapancreatic mass. CASE: A young woman presented with a retroperitoneal mass. Sonography and computed tomography (CT) showed a partially cystic mass touching the spleen and pancreas but distinct from both organs. The CT-guided aspiration cytologic diagnosis was paraganglioma. At surgery the mass was attached to the tail of the pancreas by a pedicle. The histologic diagnosis was PSCN of the pancreas. CONCLUSION: The cytologic findings in paraganglioma and PSCN may be strikingly similar, with both showing a perivascular pattern, acinar formations, cells with a moderate amount of ill-defined cytoplasm with red granularity on May-Grünwald Giemsa stain and a uniform chromatin pattern. This may be a source of diagnostic error, particularly in a patient presenting with a retroperitoneal, extrapancreatic mass.     

Fine needle aspiration cytology diagnosis of papillary tumor of the pancreas

A case of papillary tumor of the pancreas in a young woman is reported in which the nature of the tumor was recognized preoperatively by fine needle aspiration (FNA) biopsy. The larger cell clumps in the aspirate had a branching papillary appearance in which multiple layers of tumor cells surrounded central vascular stalks. This perivascular clustering of tumor cells, resembling bunches of grapes, was reflected in the subsequent histologic material. Of interest was the presence of metachromatic globules in Wright-Giemsa-stained aspiration smears, corresponding to perivascular myxoid material seen in the histologic sections, which has been described so far, among pancreatic tumors, only among papillary-type tumors.     

Thyroid metastasis from intraductal papillary-mucinous carcinoma of the pancreas. A case report

BACKGROUND: Intraductal papillary-mucinous carcinoma (IPMC) of the pancreas is a newly identified clinicopathologic entity of the exocrine pancreas. It has been considered a slowly growing and less-aggressive carcinoma with a favorable prognosis. There have been only a few documents reporting its distant metastasis and cytologic features, with no report of thyroid metastasis until the present. CASE: A case of IPMC occurred in a 45-year-old male, who was admitted with rapid growth and tenderness of the thyroid. Abdominal computed tomography showed the typical cystic dilatation of IPMC with adjacent organ metastasis. Fine needle aspiration of the thyroid yielded papillary fronds of carcinoma cells with nuclear pleomorphism, abundant cytoplasm and prominent nucleoli in a mucinous background. Immunohistochemical findings from the skin and thyroid characterized the papillary-mucinous carcinoma as having originated in the pancreas. CONCLUSION: This case suggests that papillary carcinoma fronds aspirated from the thyroid should be further differentiated from the primary site and that a pleomorphic nucleus in a mucinous background is a useful feature to exclude a thyroid origin. Before this, distant metastasis of IPMC to the skin and thyroid has not been reported. The prognosis of IPMC with wide, distant metastasis at an advanced stage is poor.