2018 Volume 57 Issue 6 Pages 300-306
Background : Large cell neuroendocrine carcinoma (LCNEC) arising from the ampulla of Vater is a rare and aggressive neoplasm, whose cytological characteristics are still poorly defined. Herein, we report a case of LCNEC of the ampulla of Vater, in which biliary duct brushing cytology combined with liquid based preparation (LBP) was useful for preoperative diagnosis.
Case : A 70-year-old man underwent biliary duct brushing cytology as part of evaluation of obstructive jaundice. The smears revealed two cell populations : one consisting of a small population of atypical cells with intracytoplasmic mucin, consistent with the characteristics of well-differentiated adenocarcinoma and another larger population of small-sized tumor cells occurring as both loosely crowded aggregates and in cohesive alveolar clusters, consistent with the features of poorly differentiated adenocarcinoma. The cells showed high nuclear-to-cytoplasmic ratios, round to oval nuclei with hyperchromasia, unevenly distributed coarsely to finely granular chromatin and occasional small nucleoli. Nuclear mitoses and rosette-like formations were also seen. In LBP, these cells were immunopositive for neuroendocrine markers. Histopathological examination revealed the diagnosis of LCNEC.
Conclusion : The cytomorphological characteristics of LCNEC of the ampulla of Vater are similar to those of LCNEC of the lung, but there are diagnostic difficulties. LBP applied to biliary duct brushing cytology provides improved diagnostic yield for LCNEC.
