[411] 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.

Pathologic Features of Pancreatic and Peri-Pancreatic Lymphomas

Characteristic	N Patients (%)
EUS-FNA Diagnosis
Negative	1 (4.5%)
Atypical	12 (54.5%)
Suspicious	3 (13.6%)
Positive	6 (27.3%)
Flow Cytometry Available for EUS-FNA Specimen	16 (72.7%)
Histologic Confirmation of Lymphoma	10 (45.5%)
Final Diagnosis*
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%)

* Final diagnosis based on all data available per case including cytologic, flow cytometric and histologic diagnoses.


Conclusions: EUS-FNA with flow cytometry is a reliable tool in diagnosing pancreatic and peri-pancreatic lymphoma, underscoring the value of having a cytopathologist in the endoscopy suite for a rapid interpretation of these lesions. When lymphoma is suspected, additional passes dedicated to flow cytometry are warranted.
Category: Cytopathology

Tuesday, March 20, 2012 9:30 AM

Poster Session III # 64, Tuesday Morning