Fine needle aspiration biopsy for preoperative workup of pancreatic cystic neoplasms: report of 4 cases.
BACKGROUND
Cystic neoplasms of the pancreas comprise a pathologically heterogeneous group of lesions that usually present with similar, nonspecific clinical features. Based on the diagnosis, treatment varies from watchful observation of the lesion to total surgical resection of the pancreas. Therefore the importance of a precise and accurate diagnosis on fine needle aspiration (FNA) biopsy cannot be overemphasized from the patient management standpoint. There is debate regarding the accuracy of FNA diagnosis of cystic lesions of the pancreas. We report 4 cases and review the literature to explore and highlight the cytologic findings and diagnostic pitfalls that may help the cytopathologist accurately distinguish mucinous cystic neoplasm (MCN), intraductal papillary mucinous neoplasm (IPMN), serous cystadenoma (SCA) and ductal adenocarcinoma (DAC).


METHODS
We present 4 cases of patients with abdominal masses who underwent either computed tomography (CT)-guided or endoscopic ultrasound (EUS)-guided FNA biopsy as preoperative workup. Based on the cytologic diagnosis, the patients underwent surgery.


CONCLUSIONS
Our cases illustrate the cytologic criteria that help the cytopathologist distinguish among MCN, IPMN, SCA and DAC. Correlation with clinical and radiologic findings is strongly advocated for accurate diagnosis. We describe the diagnostic pitfalls frequently encountered in these cases and how to avoid them.
Delatour
Nicolas Roustan
NR
Division of Anatomical Pathology, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Faculty of Medicine, The University of Ottawa, Ottawa, Ontario, Canada.
Policarpio-Nicolas
Maria Luisa C
ML
Yazdi
Hossein
H
Islam
Shahidul
S
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery; D018282:Cystadenocarcinoma, Mucinous / Q000473:pathology* / Q000601:surgery; D018284:Cystadenocarcinoma, Serous / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D018300:Papilloma, Intraductal / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed