2018 Volume 57 Issue 4 Pages 199-212
Objective : To improve the accuracy of histopathological diagnosis of pancreatic neoplasms, this study was aimed at clarifying the histological findings and the cytological findings of pancreatic tumors in EUS-FNA specimens processed by the conventional cytological smear method and cell block method.
Study Design : We investigated the data of 97 subjects who underwent EUS-FNA for pancreatic disease at our hospital between June 2013 and May 2016. The specimens were divided into three groups according to the cytological findings : normal, low-grade atypia, and high-grade atypia/carcinoma. The cytological, histological and immunohistochemical findings, as well as the clinical background, of each group were examined.
Results : Necrosis and papillary clumps were observed in 49% and 87%, respectively, of specimens from the high-grade atypia/carcinoma group. Gastric and pancreatobiliary mucus were frequently observed in the low-grade atypia group and high- grade atypia/carcinoma group, respectively. Immunohistochemistry revealed a high rate of positivity for Ki-67 and p53 in the specimens from the high grade atypia/carcinoma group. While 19% of the specimens from the high-grade atypia/carcinoma group showed negative staining for SMAD4, all the cases from the other two groups showed a positive reaction for SMAD4.
Conclusion : These results suggest that evaluation for the presence/absence of mucus and expression of cancer-related proteins is as important as that of conventional cytological features, such as the background, cell structure and cellular atypia, for the diagnosis of pancreatic disease using EUS-FNA specimens. Comprehensive analyses using cytology and simultaneous immunohistochemistry using specimens processed by the cell block method enable precise diagnosis pancreatic neoplasms.
