EUS-FNA in the Diagnosis of Pancreatic and Peri-Pancreatic Lymphoma
Amberly Nunez, Faisal Mukhtar, Isam-Eldin Eltoum. University of Alabama at Birmingham; University of Pittsburgh, Pittsburgh, PA
Background: Pancreatic and peri-pancreatic lymphomas are rare tumors that may present clinically as pancreatic adenocarcinomas do. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has recently played an increasing role in the diagnosis of non-Hodgkin lymphoma, especially when combined with ancillary studies including flow cytometry and immunohistochemistry (IHC). However, the utility of EUS-FNA in the diagnosis of pancreatic lymphoma has rarely been reported.
Design: A retrospective search was conducted at our institution on all pancreatic and peri-pancreatic EUS-FNA specimens from January, 2000 - December, 2010. Out of 2,397 pancreatic EUS-FNA specimens identified, 27 were aspirates of a lymphoproliferative process including lymphoma and atypical lymphoid population. Pap stains, Diff-Quik stains, cell block, and IHC stains, where available, were evaluated. All available histology specimens and flow cytometry data were also evaluated.
Results: During the study period, 27 aspirates from 24 patients received diagnoses of lymphoma (25) or an atypical lymphoid population (2). Twenty-five lymphoma aspirates from 22 patients, including 11 men and 11 women, aged 33-85 (mean age of 63.2 years), were evaluated. Aspirates were derived from the pancreas in 12 patients (55%) and from a peri-pancreatic lymph node or mass in 10 patients (45%). Fifteen patients (68%) presented with a primary pancreatic lymphoma while 7 patients (32%) had secondary extension from a non-pancreatic primary.
|Characteristic||N Patients (%)|
|Flow Cytometry Available for EUS-FNA Specimen||16 (72.7%)|
|Histologic Confirmation of Lymphoma||10 (45.5%)|
|Chronic lymphocytic leukemia/small lymphocytic lymphoma||3 (13.6%)|
|Diffuse large B-cell lymphoma||7 (31.8%)|
|Lymphoma, follicular center cell origin||5 (22.8%)|
|Marginal zone lymphoma||3 (13.6%)|
|T-cell/histiocyte rich large B-cell lymphoma||1 (4.5%)|
|B-cell lymphoma, not otherwise specified||3 (13.6%)|