title: Pancreatic cystic lesions without overt cytologic atypia: proposed diagnostic categories for endoscopic ultrasound-guided fine-needle aspiration cytology with utilization of fluid carcinoembryonic antigen level.
abstract: OBJECTIVE
  It was the aim of this study to examine pancreatic cyst cases that lack markedly atypical or malignant epithelium on endoscopic ultrasound-guided fine-needle aspirations.
  
  
  METHODS
  We conducted a retrospective case review study, including 24 cases that were either acellular or lacked cytologic atypia and were subsequently resected. The cases were retrospectively divided into 3 categories: (1) non-diagnostic, (2) cyst contents only, and (3) cyst contents with bland-appearing epithelium. The cyst contents were subdivided into mucinous and non-mucinous types. The cytologic diagnoses were correlated with cyst fluid carcinoembryonic antigen (CEA) levels and subsequent histologic diagnoses.
  
  
  RESULTS
  Category 1 comprised 4 cases: 2 cases (CEA >800 ng/ml) with mucin-producing neoplasms and 2 cases (CEA not determined) with microcystic serous cystadenomas. Category 2 included 4 cases with non-mucinous and 4 with mucinous contents. In the first subgroup, 2 cases (CEA >800 ng/ml) showed mucinous cystic neoplasms and 2 cases (CEA negligible or not determined) pseudocysts. In the second subgroup, there were 3 cases with neoplastic mucinous cysts (1 CEA >800 ng/ml, 2 not determined) and 1 case with a lymphoepithelial cyst with mucinous metaplasia (CEA >800 ng/ml). Almost all cases (10/11) in category 3 had neoplastic mucinous cysts regardless of the CEA levels.
  
  
  CONCLUSIONS
  The proposed 3 cytologic categories of pancreatic cystic lesion combined with cyst fluid CEA levels provide useful clinical information.
authors.affiliation: Department of Pathology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
authors.forename: Rashna
authors.initials: R
authors.lastname: Madan
authors.forename: Emma
authors.initials: E
authors.lastname: Khan
authors.forename: Nathan
authors.initials: N
authors.lastname: Cuka
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Olyaee
authors.forename: Ossama
authors.initials: O
authors.lastname: Tawfik
authors.forename: Fang
authors.initials: F
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D044963:Biopsy, Fine-Needle; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D018291:Cystadenoma, Mucinous / Q000175:diagnosis* / Q000378:metabolism; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000378:metabolism; D010181:Pancreatic Cyst / Q000145:classification / Q000175:diagnosis* / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002272:Carcinoembryonic Antigen; D009077:Mucins