Aspiration Cytopathology of Peripancreatic Space: A Clinicoradiologic and Cytopathologic Analyses of 42 Cases
0
조회
0
다운로드
0
인용
0
참고문헌
초록
Background: The pancreas is surrounded by soft tissue known as the peripancreatic space (PPS). Pathologic lesions of the PPS are infrequent and have only rarely been reported in the cytopathology literature. Methods: A retrospective review of cytopathology files at two large institutions revealed 42 cases of PPS lesions obtained by transabdominal fine needle aspiration (FNA) or endoscopic ultrasound-guided FNA over a 16-year period. Clinicoradiologic findings and follow-up information were also reviewed. Results: Patients ranged in age from 23-83 years (mean, 60 years) with an equal gender distribution. The major clinical presentations included pain, jaundice, nausea/vomiting, and abnormal liver enzymes. Radiographic characteristics included lymphadenopathy and cystic/solid soft tissue masses with a size range of 1.5 to 8 cm. Cytologically, 4 (9.5%) cases were nondiagnostic, 9 (21.5%) were diagnosed as benign, 4 (9.5%) were atypical or suspicious for cancer, and 25 (59.5%) were malignant. Six of 25 (24%) patients had metastasis of a prior known malignancy. Conclusions: FNA of PPS masses is a rare occurrence. The majority of lesions are metastatic carcinomas from a variety of primary sites. Flow cytometry and immunoperoxidase studies are useful adjuncts to determine the tumor origin. The sensitivity of PPS aspiration for a malignant diagnosis is 90% with a positive predictive value of 100%.
Abstract
Background: The pancreas is surrounded by soft tissue known as the peripancreatic space (PPS). Pathologic lesions of the PPS are infrequent and have only rarely been reported in the cytopathology literature. Methods: A retrospective review of cytopathology files at two large institutions revealed 42 cases of PPS lesions obtained by transabdominal fine needle aspiration (FNA) or endoscopic ultrasound-guided FNA over a 16-year period. Clinicoradiologic findings and follow-up information were also reviewed. Results: Patients ranged in age from 23-83 years (mean, 60 years) with an equal gender distribution. The major clinical presentations included pain, jaundice, nausea/vomiting, and abnormal liver enzymes. Radiographic characteristics included lymphadenopathy and cystic/solid soft tissue masses with a size range of 1.5 to 8 cm. Cytologically, 4 (9.5%) cases were nondiagnostic, 9 (21.5%) were diagnosed as benign, 4 (9.5%) were atypical or suspicious for cancer, and 25 (59.5%) were malignant. Six of 25 (24%) patients had metastasis of a prior known malignancy. Conclusions: FNA of PPS masses is a rare occurrence. The majority of lesions are metastatic carcinomas from a variety of primary sites. Flow cytometry and immunoperoxidase studies are useful adjuncts to determine the tumor origin. The sensitivity of PPS aspiration for a malignant diagnosis is 90% with a positive predictive value of 100%.
참고문헌 (17)
- Brand B, "Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery", Scand J Gastroenterol, 35, pp.1221~1228 (2000)
- de Roos WK, "Assessment of resectability of carcinoma of the pancreatic head by ultrasonography and computed tomography: a retrospective analysis", Eur J Surg Oncol, 16, pp.411~416 (1990)
- Pasanen PA, "Janatuinen EK, Pirinen AE. A comparison of ultrasound, computed tomography and endoscopic retrograde cholangiopancreatography in the differential diagnosis of benign and malignant jaundice and cholestasis", Eur J Surg, 159, pp.23~29 (1993)
- Snady H, "Endoscopic ultrasonography compared with computed tomography with ERCP in patients with obstructive jaundice or small peri-pancreatic mass", Gastrointest Endosc, 38, pp.27~34 (1992)
- Cahn M, "Impact of endoscopic ultrasound with fine-needle aspiration on the surgical management of pancreatic cancer", Am J Surg, 172, pp.470~472 (1996)
- Erickson RA, "Impact of endoscopic ultrasound on the management and outcome of pancreatic carcinoma", Am J Gastroenterol, 95, pp.2248~2254 (2000)
- Di Stasi M, "Ultrasound-guided fine needle biopsy of pancreatic masses: results of a multicenter study", Am J Gastroenterol, 93, pp.1329~1333 (1998)
- Frazee RC, "Endoscopic ultrasound for peripancreatic masses", Am J Surg, 174, pp.596~598 (1997)
- Suits J, "Endoscopic ultrasound and fine needle aspiration for the evaluation of pancreatic masses", Arch Surg, 134, pp.639~642 (1999)
- Benning TL, "Fine needle aspiration of metastatic and hematologic malignancies clinically mimicking pancreatic carcinoma", Acta Cytol, 36, pp.471~476 (1992)
- Nicol TL, "The accuracy of combined cytopathologic and flow cytometric analysis of fine-needle aspirates of lymph nodes", Am J Clin Pathol, 114, pp.18~28 (2000)
- Siebert JD, "Utility of flow cytometry immunophenotyping for the diagnosis and classification of lymphoma in community hospital clinical needle aspiration", biopsies, 2000, pp.124, 1792~1799
- Moriarty AT, "Immunophenotyping of cytologic specimens by flow cytometry", Diagn Cytopathol, 9, pp.252~258 (1993)
- Simsir A, "Immunophenotypic analysis of non-Hodgkin’s lymphomas in cytologic specimens: a correlative study of immunocytochemical and flow cytometric techniques", Diagn Cytopathol, 20, pp.278~284 (1999)
- Oien KA, "Pathologic evaluation of unknown primary cancer", Semin Oncol, 36, pp.8~37 (2009)
- Tascilar M, "Immunohistochemical labeling for the Dpc4 gene product is a specific marker for adenocarcinoma in biopsy specimens of the pancreas and bile duct", Am J Clin Pathol, 116, pp.831~837 (2001)
- Bishop JA, "Napsin A and thyroid transcription factor-1 expression in carcinomas of the lung, breast, pancreas, colon, kidney, thyroid, and malignant mesothelioma", Hum Pathol, 41, pp.20~25 (2010)