Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA,
Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA,
Monogr Clin Cytol. 2020;26:53-73. doi: 10.1159/000455735. Epub 2020 Sep 28.
Inflammatory, developmental, and neoplastic lesions may all present as cystic masses on imaging. Pseudocyst is the most common of these and presents in association with a history of pancreatitis. Pancreatic cystic neoplasms are uncommon compared to solid neoplasms. They often present incidentally; therefore, an incidentally discovered cyst in the pancreas should be assessed with a high index of suspicion for neoplasm. The most common and frequently encountered cystic neoplasms include serous cystadenoma, mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm. Less common epithelial cystic neoplasms include acinar cell cystadenoma and cystadenocarcinoma. Any solid neoplasm occurring in the pancreas or vicinity of the pancreas that has undergone cystic degeneration may present as a cystic mass. Non-epithelial lesions, such as lymphangioma, are also included in the differential diagnosis. The work-up needs to begin with a review of the clinical and imaging findings to establish a differential diagnosis. The primary focus of the pathologist will be first on differentiating mucinous from non-mucinous entities, since this will determine if the mass is an intraductal papillary mucinous neoplasm or a mucinous cystic neoplasm. If it is mucinous, the next step is to determine if the cystic neoplasm contains cells with high-grade cytological features. If it is non-mucinous, the pathologist needs to assess for neoplastic cells that would indicate a different neoplastic process. The cytological features need to be integrated with cyst fluid carcinoembryonic antigen and amylase measurements. Currently, molecular pathology is being integrated into the analysis of pancreatic cyst fluids. Here we will cover the cytological features and ancillary findings in cystic masses of the pancreas.
在影像学上，炎症、发育和肿瘤性病变都可能表现为囊性肿块。假性囊肿是最常见的一种，与胰腺炎病史有关。与实体瘤相比，胰腺囊性肿瘤并不常见。它们通常是偶然发现的；因此，胰腺内偶然发现的囊肿应高度怀疑为肿瘤。最常见和常遇到的囊性肿瘤包括浆液性囊腺瘤、黏液性囊腺瘤和导管内乳头状黏液性肿瘤。较少见的上皮性囊性肿瘤包括腺泡细胞囊腺瘤和囊腺癌。任何发生在胰腺或胰腺附近并经历囊性变性的实体瘤都可能表现为囊性肿块。非上皮性病变，如淋巴管瘤，也包括在鉴别诊断中。检查需要从回顾临床和影像学发现开始，以建立鉴别诊断。病理学家的主要重点首先是区分黏液性和非黏液性实体，因为这将决定该肿块是导管内乳头状黏液性肿瘤还是黏液性囊腺瘤。如果是黏液性的，下一步是确定囊性肿瘤是否含有具有高级别细胞学特征的细胞。如果是非黏液性的，病理学家需要评估是否存在提示不同肿瘤过程的肿瘤细胞。细胞学特征需要与囊液癌胚抗原和淀粉酶测量值相结合。目前，分子病理学已被纳入胰腺囊液分析中。在这里，我们将介绍胰腺囊性肿块的细胞学特征和辅助发现。
