Cytopathology of the pancreatobiliary tract-the agony, and sometimes, the ease of it

Abstract

Pancreatic cytopathology is recognized as a rapid, reliable, safe and cost-beneficial modality of investigation of pancreatic mass lesions. Optimal cytodiagnosis depends on multiple factors including sample quality, and expertise of the cytopathologist and endoscopist. This article discusses key cytologic features of specific tumor types, specimen handling, differential diagnoses and pitfalls.

Keywords: Cytology; biliary tract; brush cytology; endoscopic retrograde cholangiopancreatography; endoscopic ultrasound; fine needle aspiration; pancreas.

Figure 1

A. benign pancreatic ductal cells in a honey comb pattern (DQ stain, 400×); B. benign pancreatic acinar cells (Pap stain, 400×)

Figure 2

Contaminant duodenal cells in a cohesive uniform group (Pap stain, 400×)

Figure 3

A. pancreatic pseudocyst aspiration, showing histocytes with phagocytic debris; B. pseudocyst wall with numerous histocytes (H&E, 200×)

Figure 4

Mucinous cystic neoplasm with disorderly sheets of pleomorphic columnar cells with cytoplasmic mucin vacuoles (H&E, 400×)

Figure 5

Intraductal papillary mucinous tumor, with sheets of round cells with abundant mucin (Pap stain, 400×)

Figure 6

A. solid and papillary epithelial neoplasm showing papillary formation (Pap stain, 400×); B. solid and papillary epithelial neoplasm with stromal cores (Pap stain, 200×)

Figure 7

Solid and papillary epithelial neoplasm, with papillary and microacinar formations (H&E, 200×)

Figure 8

Pancreatic ductal adenocarcinoma, displaying prominent pleomorphism, loss of polarity, and cytomegaly (DQ stain, 400×)

Figure 9

Ductal adenocarcinoma with disordered sheets of cells displaying a drunken honeycomb pattern, grooved nuclei and prominent nucleoli (Pap stain, 400×) megaly (DQ stain, 400×)

Figure 10

A. acinar cell carcinoma with solid overlapping nested cluster of large cells with granular cytoplasm and round nuclei (Pap stain, 400×); B. acinar cell carcinoma with numerous stripped nuclei in the background (DQ stain, 200×)

Figure 11

Carcinoid tumor with monotonous plasmacytoid cells with finely granular cytoplasm (DQ, 400×)

Figure 12

Anaplastic carcinoma of the pancreas, displaying large, single and multinucleated cells (Pap stain, 400×)

Figure 13

Adenosquamous carcinoma, showing occasional squamoid tumor cells with orangeophilic dense cytoplasm with distinct cell borders as well as glandular tumor cells with hypochromatic nuclei and prominent nucleoli (Pap stain, 400×)

Figure 14

Burkitt lymphoma obtained by endoscopic retrograde cholangiopancreatography (ERCP); note the characteristic lymphoma cells with vacuolated blue cytoplasm and background lymphoglandular bodies (DQ stain, 400×)