Department of Laboratory Medicine and Pathology, University of Minnesota, University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota, USA.
Cancer Cytopathol. 2013 Jun;121(6):298-310. doi: 10.1002/cncy.21259. Epub 2012 Dec 5.
Solid pseudopapillary neoplasm (SPPN) is a rare tumor of unknown origin that occurs predominantly in the body or tail of the pancreas in young women. The authors recently identified cercariform (Greek: tailed) cells, similar to those described in urothelial carcinomas, as a consistent cytologic feature in ultrasound-guided fine-needle aspiration (EUS-FNA) samples from SPPNs. The objective of the current multi-institutional study was to define the value of these cells in the differential diagnosis of SPPN with other neoplasms characterized cytologically by the presence of monotonous, uniform cells in pancreatic aspirates: pancreatic neuroendocrine tumors (Pan-NETs) and acinar cell carcinomas (ACCs).
The files of 4 academic hospitals were searched for SPPNs, Pan-NETs, and ACCs that were diagnosed by EUS-FNA. The slides were reviewed, and several cytologic features were recorded semiquantitatively to identify discriminating features between SPPNs, Pan-NETs, and ACCs.
From the analysis of 18 SPPNs, 4 ACCs, and 20 Pan-NETs, the following cytologic features were identified as common to all 3 neoplasms: single cells and rosettes/acinar cell groups, round-to-plasmacytoid cells, pale-to-granular cytoplasm, fine vacuoles, and binucleated cells. Papillary structures, cercariform cells, large cytoplasmic vacuoles, reniform nuclei, hyaline globules/magenta-colored material, and degenerative features (cholesterol crystals, calcifications, foam cells, or giant cells) were significantly more common in SPPNs. Prominent nuclear grooves were encountered in only 4 of 18 SPPNs.
The current results indicated that the presence of cercariform cells is another useful clue for the cytologic diagnosis of SPPN in challenging cases.
实性假乳头状瘤（SPPN）是一种来源不明的罕见肿瘤，主要发生在年轻女性的胰腺体部或尾部。作者最近在 SPPN 的超声引导下细针抽吸（EUS-FNA）样本中发现了类似尿路上皮癌的具尾（希腊语：有尾）细胞，这是一种一致的细胞学特征。本多机构研究的目的是确定这些细胞在鉴别诊断具有细胞学特征的胰腺肿瘤中的价值，这些特征为胰腺抽吸物中存在单调、均匀的细胞：胰腺神经内分泌肿瘤（Pan-NETs）和腺泡细胞癌（ACCs）。
检索了 4 家学术医院的 SPPN、Pan-NETs 和 ACC 的文件，这些肿瘤是通过 EUS-FNA 诊断的。对幻灯片进行了回顾，并记录了几种细胞学特征，以便在 SPPN、Pan-NETs 和 ACC 之间识别出有区别的特征。
从对 18 个 SPPN、4 个 ACC 和 20 个 Pan-NETs 的分析中，确定了以下 3 种肿瘤均具有的细胞学特征：单个细胞和玫瑰花/腺泡细胞群、圆形至浆细胞样细胞、浅至颗粒状细胞质、细空泡和双核细胞。乳头状结构、具尾细胞、大的细胞质空泡、肾形核、透明小体/紫红色物质和退行性特征（胆固醇结晶、钙化、泡沫细胞或巨细胞）在 SPPN 中更为常见。仅在 18 个 SPPN 中的 4 个中遇到明显的核沟。
目前的结果表明，具尾细胞的存在是在有挑战性的病例中对 SPPN 进行细胞学诊断的另一个有用线索。
