Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Diagn Pathol. 2019 Oct;42:87-91. doi: 10.1016/j.anndiagpath.2019.07.006. Epub 2019 Jul 27.
Pancreatic serous cystadenoma (SCA) is a benign neoplastic lesion with a distinctive gross and microscopic appearance consisting of numerous thin-walled cysts lined by uniform epithelial cells with clear cytoplasm and small nuclei. The vast majority of serous cystadenomas are benign. Pancreatic SCA has rarely been reported in association with other pancreatic lesions. We present a challenging case in which a cystic and solid pancreatic mass was identified on imaging studies. FNA was performed and showed clusters of atypical cells with significant nuclear pleomorphism (>4:1), disorganized, overlapping nuclei, and prominent nucleoli. The FNA diagnosis was positive for malignancy, consistent with adenocarcinoma. The patient underwent neoadjuvant therapy and pancreaticoduodenectomy. Final pathology showed a serous cystadenoma associated with small foci of high-grade PanIN. The lack of invasive adenocarcinoma in the resection specimen was most likely due to complete response of the tumor to neoadjuvant chemoradiation therapy, but it is also possible that only high-grade PanIN was present initially. To our knowledge, this is the first reported case of SCA and high grade PanIN/PDAC that was assessed by FNA. We discuss the cytologic differential diagnosis and how to avoid potential pitfalls highlighted by this case.
胰腺浆液性囊腺瘤（SCA）是一种具有独特大体和镜下表现的良性肿瘤性病变，由许多薄壁囊泡组成，囊壁内衬单层均匀的上皮细胞，胞质透明，细胞核小。绝大多数浆液性囊腺瘤为良性。胰腺 SCA 很少与其他胰腺病变相关报道。我们报告了一例具有挑战性的病例，该病例在影像学检查中发现囊性和实性胰腺肿块。进行了细针穿刺抽吸（FNA），显示出具有显著核异型性（>4:1）、紊乱重叠核、明显核仁的异型细胞簇。FNA 诊断为恶性，符合腺癌。患者接受了新辅助治疗和胰十二指肠切除术。最终病理显示浆液性囊腺瘤伴高级别 PanIN 小灶。切除标本中无浸润性腺癌可能是由于肿瘤对新辅助放化疗完全反应，但也可能最初仅存在高级别 PanIN。据我们所知，这是首例通过 FNA 评估的 SCA 和高级别 PanIN/PDAC 病例。我们讨论了细胞学鉴别诊断以及如何避免该病例突出显示的潜在陷阱。
