Kwon Minji, Hong Seung-Mo, Lee Kyoungbun, Kim Haeryoung
Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Pathology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.
J Pathol Transl Med. 2024 Jul;58(4):182-190. doi: 10.4132/jptm.2024.06.25. Epub 2024 Jul 9.
Acinar cell carcinoma (ACC) is a rare malignant epithelial neoplasm, which shares many cytomorphological features with other non-ductal pancreatic neoplasms such as pancreatic neuroendocrine neoplasm (PanNEN) and solid-pseudopapillary neoplasm (SPN). Due to the relative rarity of these tumors, pathologists are less familiar with the cytological features, especially on liquid-based cytology (LBC) which has been relatively recently introduced for endoscopic ultrasound-guided fine needle aspiration specimens.
We evaluated the detailed cytological features of 15 histologically confirmed ACC (7 conventional smears [CS], 8 LBC), and compared them with the LBC features of SPN (n = 9) and PanNEN (n = 9).
Compared with CS, LBCs of ACC demonstrated significantly less bloody background. All ACCs demonstrated prominent nucleoli and macronucleoli on LBC. On comparison with the LBC features of SPN and PanNEN, most ACCs demonstrated a necrotic background with apoptotic debris while PanNEN and SPN did not show these features. Acinar structures were predominantly observed in ACC, while frequent pseudopapillary structures were seen only in SPN. Prominent nucleoli and macronucleoli were only seen in ACC.
ACC had characteristic cytological features that could be observed on LBC preparations, such as high cellularity, necrotic/apoptotic background, nuclear tangles, acinar arrangement of cells, and macronucleoli. These findings also help distinguish ACC from PanNEN and SPN on LBC. It is important to be familiar with these features, as an accurate diagnosis on endoscopic ultrasound-guided fine needle aspiration cytology would have impact on the management of the patient.
腺泡细胞癌（ACC）是一种罕见的恶性上皮性肿瘤，它与其他非导管性胰腺肿瘤如胰腺神经内分泌肿瘤（PanNEN）和实性假乳头状肿瘤（SPN）具有许多细胞形态学特征。由于这些肿瘤相对罕见，病理学家对其细胞学特征不太熟悉，尤其是在最近才引入用于内镜超声引导下细针穿刺标本的液基细胞学（LBC）方面。
我们评估了15例经组织学证实的ACC的详细细胞学特征（7例传统涂片[CS]，8例LBC），并将它们与SPN（n = 9）和PanNEN（n = 9）的LBC特征进行比较。
与CS相比，ACC的LBC显示出血性背景明显较少。所有ACC在LBC上均显示出明显的核仁和大核仁。与SPN和PanNEN的LBC特征相比，大多数ACC显示出带有凋亡碎片的坏死背景，而PanNEN和SPN未显示这些特征。在ACC中主要观察到腺泡结构，而仅在SPN中频繁见到假乳头状结构。仅在ACC中可见明显的核仁和大核仁。
ACC具有可在LBC制片上观察到的特征性细胞学特征，如高细胞密度、坏死/凋亡背景、核缠结、细胞腺泡排列和大核仁。这些发现也有助于在LBC上区分ACC与PanNEN和SPN。熟悉这些特征很重要，因为内镜超声引导下细针穿刺细胞学的准确诊断会对患者的治疗产生影响。
