Clinical history: A 65-year-old gentleman presented with painless obstructive jaundice and imaging studies revealed a 3.4 cm mass in the head of the pancreas. Endoscopic ultrasound-guided fine needle aspirate of the mass was performed.
Cytologic findings
The smears show two distinct cell populations:
- Benign pancreatic acinar cells:
- Cohesive "grape-like" aggregates
- Polygonal-shaped acinar cells
- Nuclei: eccentric, round, evenly distributed fine granular chromatin.
- Malignant cells:
- Irregular clusters with overlapping nuclei ("drunken honeycomb")
- Isolated single cells with marked atypia
- Moderate to marked cytologic atypia:
- Nuclear membrane: notches, grooves, convolutions
- Nuclear size: enlarged, anisonucleosis (>4:1 in one sheet)
- Chromatin clumping and nuclear clearing
- Mitoses
- Cytoplasmic mucin vacuoles
Diagnosis
Adenocarcinoma
Case writer: Dr Noel Chia
There are two populations of cells . One subset shows pleomorphism and nucleoli and vague acini.
Malignant smears.
Favour adenocarcinoma.
I would like to confirm with Ck7, CK 20. CEA, synaptophyscin. chromogranin on cell block.
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Note: If radiologic and clinical findings match the cytologic findings, ancillary tests may not be required!