Pancreatic Fine-Needle Aspiration Cytology in Patients < 35-Years of Age: A Retrospective Review of 175 Cases Spanning a 16-Year Period
Megan Redelman, Howard H Wu, Harvey M Cramer. Indiana University School of Medicine, Indianapolis, IN
Background: Pancreatic lesions in young patients are relatively rare and, to our knowledge, the clinical value of pancreatic fine needle aspiration (FNA) in patients < 35 years of age has not been previously established by any other large retrospective studies.
Design: A computerized search of our laboratory information system was performed for the 16-year period (1994-2010) and all pancreatic FNA cases performed on patients < 35 years of age were identified. All FNA and all available correlating surgical pathology reports were reviewed.
Results: There were a total of 175 cases of pancreatic FNA performed on 111 males and 65 females under the age of 35 (range: 8-34, mean: 27 years). The FNA diagnoses included 39 malignancies, 114 negative for malignancy, 8 atypia, and 14 cases that were nondiagnostic. Of the 39 malignant FNA cases, the diagnoses included 19 pancreatic neuroendocrine tumors (PNET), 11 solid pseudopapillary neoplasms (SPN), 5 adenocarcinomas, 2 metastatic adenocarcinomas, 1 gastrointestinal stromal tumor, and 1 melanoma. Histologic follow-up was available in 22 of the 39 malignant cases (56%), and malignancy was confirmed in all cases. However, 1 case of SPN had been misclassified as PNET by FNA. Of the 114 FNAs diagnosed as negative for malignancy, 24 had histologic follow-up which included 9 cases of chronic pancreatitis, 6 benign cysts, 3 mucinous cystic neoplasms, 3 serous cystadenomas, 1 PNET, 1 focal epithelial atypia, and 1 with no pathologic change. Follow-up histology was available for 3 of the 8 cases diagnosed as 'atypia' by FNA and included 1 benign cyst, 1 chronic pancreatitis, and 1 serous cystadenoma. Histologic follow-up was available in 2 of the 14 nondiagnostic FNAs, both of which showed PNET. The overall sensitivity was 85% and the specificity was 100%.
Conclusions: The majority of the pancreatic lesions in patient under 35 years were benign with malignant neoplasms accounting for less than one quarter of the cases. The most common neoplasms in this age group included PNET, followed by SPN with both tumors accounting for 75% of all the neoplasms encountered in this age group. Mucinous cystic neoplasm was the most common cause of a false-negative FNA diagnosis. FNA is a clinically useful diagnostic test in patients < 35 years of age with pancreatic lesions.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 62, Tuesday Morning