Grading Dysplasia in Mucin-Producing Cystic Neoplasms of the Pancreas on Fine Needle Aspiration.
Mark Fons, Mohammad Atieh, Girish Venkataraman, Beatriz Sanchez, Sherri Yong, Guliz Barkan, Eva Wojcik, Umesh Kapur. Loyola University Health Center, Maywood, IL
Background: In mucin-producing neoplasms of the pancreas, the best predictor of prognosis is the presence of invasive carcinoma. 10% of mucinous cystic neoplasms (MCN) and 30% of intraductal papillary mucinous neoplasms (IPMNs) harbor invasion. Fine needle aspiration (FNA) is a primary modality for diagnosis of these lesions; however, grading dysplasia and detecting invasion in these lesions by cytology poses a diagnostic challenge. Our aim is to determine cytomorphologic features of high-grade dysplasia and invasion.
Design: A database search was performed for purely cystic, pancreatic FNAs over a 10 year period (2000-2010) which had histologic follow-up. Non-diagnostic cases on FNA were excluded. Diff-Quik and Papanicolau stained direct smears were scored blindly for the presence of 23 cytologic features without knowledge of histologic outcome: Mucinous background, cellularity, small cell groups, flat sheets, cellular crowding, 3-dimensional (3D) clusters, glandular formation, necrosis, nuclear pleomorphism, high N/C ratio, nuclear grooves, nuclear membrane irregularity, nuclear overlapping, nuclear molding, nucleoli, nuclear enlargement, parachromatin clearing, hyperchromasia, single intact cells, papillae, mitoses, and atypical mitoses. On a four point scale, scores of 0 or 1 were considered negative for a feature, while scores of 2 or 3 were considered positive. Chi-square analysis was performed to determine the cytomorphologic features that are predictive of dysplasia.
Results: 31 cases of MCNs by FNA (24 female,7 male, average age = 64 years), of which 12 were adenocarcinomas, 13 were IPMNs [6 low, 4 moderate, 3 high-grade dysplasia] and 6 were mucinous cystadenomas [4 low, 1 moderate, 1 high-grade dysplasia] on histology. The cytomorphologic features most predictive of high-grade dysplasia and carcinoma combined were: Presence of prominent nucleoli (P=0.031), small cell groups (P=0.006), 3D clusters (P=0.027). In addition, the presence of single intact cells (P=0.022) and mitoses (P=0.038) were found to be suggestive of invasion.
Conclusions: - The diagnosis of high-grade dysplasia and invasive carcinoma in mucin-producing cystic neoplasms of the pancreas can be suggested using the cytomorphologic features.
- High-grade dysplasia and invasive carcinoma was found in a significant number [55%] of the cases presented in this study
- Grading of dysplasia on FNA may aid in guiding theraputic intervention in select patients
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 51, Monday Morning