Journal of Pathology and Translational Medicine

Original Article

Liquid-based cytology features of pancreatic acinar cell carcinoma: comparison with other non-ductal neoplasms of the pancreas: Minji Kwon, Seung-Mo Hong, Kyoungbun Lee, Haeryoung Kim; J Pathol Transl Med. 2024;58(4):182-190. Published online July 9, 2024; DOI: https://doi.org/10.4132/jptm.2024.06.25

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Abstract PDF: Background
Acinar cell carcinoma (ACC) is a rare malignant epithelial neoplasm, which shares many cytomorphological features with other non-ductal pancreatic neoplasms such as pancreatic neuroendocrine neoplasm (PanNEN) and solid-pseudopapillary neoplasm (SPN). Due to the relative rarity of these tumors, pathologists are less familiar with the cytological features, especially on liquid-based cytology (LBC) which has been relatively recently introduced for endoscopic ultrasound-guided fine needle aspiration specimens.
Methods
We evaluated the detailed cytological features of 15 histologically confirmed ACC (7 conventional smears [CS], 8 LBC), and compared them with the LBC features of SPN (n = 9) and PanNEN (n = 9).
Results
Compared with CS, LBCs of ACC demonstrated significantly less bloody background. All ACCs demonstrated prominent nucleoli and macronucleoli on LBC. On comparison with the LBC features of SPN and PanNEN, most ACCs demonstrated a necrotic background with apoptotic debris while PanNEN and SPN did not show these features. Acinar structures were predominantly observed in ACC, while frequent pseudopapillary structures were seen only in SPN. Prominent nucleoli and macronucleoli were only seen in ACC.
Conclusions
ACC had characteristic cytological features that could be observed on LBC preparations, such as high cellularity, necrotic/apoptotic background, nuclear tangles, acinar arrangement of cells, and macronucleoli. These findings also help distinguish ACC from PanNEN and SPN on LBC. It is important to be familiar with these features, as an accurate diagnosis on endoscopic ultrasound–guided fine needle aspiration cytology would have impact on the management of the patient.

Reviews

Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration cytology/biopsy for pancreatic lesions: Haeryoung Kim, Kee-Taek Jang; J Pathol Transl Med. 2020;54(5):367-377. Published online August 31, 2020; DOI: https://doi.org/10.4132/jptm.2020.07.21

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Pathologic interpretation of endoscopic ultrasound–guided fine needle aspiration (EUS-FNA) cytology/biopsy specimens is one of the most challenging tasks in cytology and surgical pathology practice, as the procedure often yields minimal amounts of diagnostic material and contains contaminants, such as blood cells and normal intestinal mucosa. EUS-FNA cytology/biopsy will nevertheless become a more popular procedure for evaluation of various pancreatic lesions because they are difficult to approach with conventional endoscopic procedures. Pathologists should understand the structural differences and limitations of EUS-FNA that make pathologic diagnosis difficult. Ancillary tests are available for differential diagnosis of EUS-FNA for various pancreatic lesions. Immunostains are the most commonly used ancillary tests, and pathologists should able to choose the necessary panel for differential diagnosis. Pathologists should review clinical history and radiologic and/or EUS findings before selecting an immunostain panel and making a pathologic diagnosis. In addition, one’s threshold of malignancy should be adjusted according to the appropriate clinical setting to avoid under-evaluation of pathologic diagnoses. Clinico-pathologic correlation is essential in pathologic evaluation of EUS-FNA for pancreatic lesions. Pathologists can reduce errors by correlating clinical and radiologic findings when evaluating EUS-FNA. Some molecular tests can be applied in differential diagnosis of pancreatic neoplastic and cystic lesions. Molecular data should be used as supportive evidence of a specific disease entity, rather than direct evidence, and should be correlated with clinico-pathologic findings to avoid errors in pathologic diagnosis.

Citations

Citations to this article as recorded by

A prospective randomized noninferiority trial comparing conventional smears and SurePathTM liquid-based cytology in endoscopic ultrasound-guided sampling of esophageal, gastric, and duodenal lesions
Jae Chang Jun, Sang Hyub Lee, Han Myung Lee, Sang Gyun Kim, Hyunsoo Chung, Joo Seong Kim, Namyoung Park, Jin Ho Choi, Yoonjin Kwak, Soo-Jeong Cho
Medicine.2023; 102(29): e34321. CrossRef
Double Ki-67 and synaptophysin labeling in pancreatic neuroendocrine tumor biopsies
Bokyung Ahn, Jin Kying Jung, HaeSung Jung, Yeon-Mi Ryu, Yeon Wook Kim, Tae Jun Song, Do Hyun Park, Dae wook Hwang, HyungJun Cho, Sang-Yeob Kim, Seung-Mo Hong
Pancreatology.2022; 22(3): 427. CrossRef
Comparison of Endoscopic Ultrasound-Guided Fine Needle Aspiration with 19-Gauge and 22-Gauge Needles for Solid Pancreatic Lesions
Changjuan Li, Jianwei Mi, Fulai Gao, Xinying Zhu, Miao Su, Xiaoli Xie, Dongqiang Zhao
International Journal of General Medicine.2021; Volume 14: 10439. CrossRef

Genomic Landscapes of Pancreatic Neoplasia: Laura D. Wood, Ralph H. Hruban; J Pathol Transl Med. 2015;49(1):13-22. Published online January 15, 2015; DOI: https://doi.org/10.4132/jptm.2014.12.26

11,580 View
113 Download
17 Web of Science
14 Crossref

Abstract PDF

Pancreatic cancer is a deadly disease with a dismal prognosis. However, recent advances in sequencing and bioinformatic technology have led to the systematic characterization of the genomes of all major tumor types in the pancreas. This characterization has revealed the unique genomic landscape of each tumor type. This knowledge will pave the way for improved diagnostic and therapeutic approaches to pancreatic tumors that take advantage of the genetic alterations in these neoplasms.

Citations

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Case Report

Triple Synchronous Cancers of Stomach, Pancreas, and Kidney.: Seung Koo Lee, Byung Ha Choi, Shin Kwang Khang, Byung Sik Kim, Jooryung Huh; Korean J Pathol. 2001;35(6):547-550.

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Abstract: Synchronous occurrence of triple distinct malignant tumors in the same patient is very rare. We report a unique case of a triple cancer occurring in a 70-year-old Korean woman with synchronous signet ring cell carcinoma of the stomach, renal cell carcinoma of the conventional type of the left kidney, and invasive ductal adenocarcinoma and intraductal papillary carcinoma of the pancreas. All three cancers were successfully resected simultaneously by total gastrectomy, nephrectomy, and partial pancreatectomy with corresponding lymphadenectomies. This patient tolerated these surgical procedures well and led a normal healthy life during the 18 months of follow-up. In summary, a successful resection of synchronous triple cancers which has never been previously reported in such combination, is described.

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