Pancreatitis
Acute pancreatitis Acute pancreatitis results from the enzymatic autodestruction of the parenchyma and the accompanying acute inflammatory response. It is most commonly associated with biliary tract disease or alcoholism. The diagnosis rests on clinical findings and laboratory evidence, and the radiologic appearance is usually not suggestive of a mass lesion. For this reason, it is […]
Solid tumors
Solid tumors Ductal adenocarcinoma Acinar cell carcinoma Solid-pseudopapillary tumor Endocrine tumors Metastatic tumors
Cystic tumors
Cystic tumors Pancreatic cystic tumors account for about 5% of pancreatic neoplasms. They also include cystic dilatations of intraductal neoplasms, cystic degenerations of solid neoplasms (solid-pseudopapillary tumor), and solid neoplasms with focal cystic change (ductal adenocarcinoma with cystic degeneration, cystic acinar cell carcinoma, cystic pancreatic endocrine tumor). Serous cystadenoma It usually occurs in elderly women, […]
Pancreatic pseudocysts
Pancreatic pseudocysts Pancreatic pseudocysts occur in the setting of acute pancreatitis, resulting from autodigestion of the parenchyma. They account for the vast majority of pancreatic cystic lesions (75-90%). Pseudocysts can be rarely associated with trauma or pancreatic surgery. By definition, a pseudocyst lacks an epithelial lining. It is an unilocular thick-walled lesion, composed of an […]
Acinar cell carcinoma
Acinar cell carcinoma It is a rare, aggressive malignancy, usually arising in adults, but it has been reported in children and adolescents as well. Cytologic diagnostic features Groups of cells in nests, cords or acini Single cells Nuclear irregularity, crowding, overlapping Increased N/C ratio Conspicuous nucleoli Moderately abundant granular cytoplasm Absence of ductal epithelium The […]
Anatomy and histology of the pancreas
Ductal adenocarcinoma
Ductal adenocarcinoma It is the most common pancreatic tumor (85-90%). It usually occurs in elderly patients and most commonly involve the head of the pancreas. It has been associated with smoking and recurrent pancreatitis and its prognosis is poor. Cytologic diagnostic features (moderately to poorly differentiated tumors) Increased cellularity Crowded sheets (with feathered edges) Single […]
Reporting terminology
Reporting terminology Diagnostic terminology for pancreatic FNA used empirically a five-tier system including the following categories: Negative for malignant cells Atypical cells present Suspicious cells present Positive for malignant cells Non-diagnostic specimen A negative diagnosis in the setting of a radiologically detected mass implies either a failure to sample the lesion or the presence of […]
Metastatic tumors
Metastatic tumors FNA is particularly useful in documenting a metastatic malignancy involving the pancreas. Lung carcinoma (small cell and squamous cell) Breast carcinoma Non-Hodgkin lymphoma Renal cell carcinoma Because ductal cell adenocarcinoma is by far the most common pancreatic tumor, any aspirate showing cytologic features unusual for this diagnosis should raise the possibility of a […]
Fine needle aspiration (FNA) and other sampling methods
Fine needle aspiration (FNA) Fine needle aspiration (FNA) is the sampling method of choice for evaluating pancreatic masses. It is a procedure with few complications which can confirm malignancy in a minimally invasive manner. It is effective in the diagnosis of tumors, but cystic pancreatic lesions and non-neoplastic processes may also be evaluated by FNA. […]