[410] Metastatic Tumors to the Pancreas Diagnosed by Fine Needle Aspiration: A Multi-Institutional Analysis of 38 Cases

Michelle D Reid, Harold C Sullivan, Evita Henderson-Jackson, Barbara A Centeno. Emory University School of Medicine, Atlanta, GA; H. Lee Moffitt Cancer Center, Tampa, FL

Background: Most primary malignant pancreatic neoplasms are of ductal origin however non-pancreatic tumors rarely metastasize to the pancreas. Because of their radiologic appearance and sometimes misleading cytology these cancers may simulate primary pancreatic tumors leading to erroneous diagnoses and delayed/inappropriate management. We present our multi-institutional experience with secondary pancreatic tumors diagnosed exclusively by fine needle aspiration (FNA) with/without the use of immunocytochemistry (ICC).
Design: A retrospective review of the pathology departments' archives from December 1988-April 2005 (Emory) and October 2008-June 2012 (Moffitt) yielded 38 cases fitting the criteria for secondary non-hematopoietic pancreatic malignancies. Demographic, clinical, cytologic and diagnostic data were collected.
Results: Patient demographics are summarized in Table 1.

Table 1. Patient Demographics
MalesFemalesAge RangeMeanHOP, Uncinate ProcessBOPTOPPancreas, NOS
261223-827118947
68%32%  47%24%11%18%
HOP, head of pancreas; BOP, body of pancreas; TOP, tail of pancreas

There was 1 small cell carcinoma (SCC) of gallbladder and 1 metastatic testicular embryonal carcinoma in a 23 year-old. There were 9 lung cancers (2 squamous, 5 adenocarcinomas, 1 giant cell and 1 SCC); 2/38 (5%) patients had no history of malignancy prior to FNA (1 testicular and 1 lung cancer). ICC supported the diagnosis in 21/38 (55%) cases while morphologic comparison to the prior resection/biopsy supported the diagnosis in 9/38 (24%). Tumor types are summarized in Table 2.

Table 2. Type and Origin of Metastatic Tumors
Tumor TypeNumber = n%
Lung924%
Melanoma38%
RCC1745%
Gallbladder12.6%
Intrahepatic duct12.6%
Colon25%
HCC25%
Gastric12.6%
Testis12.6%
Ileal conduit12.6%
RCC, renal carcinoma; HCC, hepatocellular carcinoma.


Conclusions: RCC was the most common metastatic tumor identified on pancreatic FNA, followed by lung carcinoma. The pancreatic head/uncinate process was the most common site of involvement followed by the body. Masses in this location can lead to erroneous radiologic interpretation as pancreatic primaries. However a history of carcinoma (which was given in the majority of our cases) should facilitate accurate diagnosis. In tumors with unusual presentation and obscure cytomorphology a higher index of suspicion is needed to ensure accurate diagnosis and staging. Secondary tumors should always be considered in the setting of pancreatic neoplasms, even in the very young.
Category: Cytopathology

Tuesday, March 5, 2013 1:00 PM

Poster Session IV # 79, Tuesday Afternoon

 

Close Window