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Fine-needle aspiration of intrapancreatic accessory spleen: Cytomorphologic features and differential diagnosis
Article first published online: 1 FEB 2012
Copyright © 2012 American Cancer Society
Volume 120, Issue 4, pages 261–268, 25 August 2012
How to Cite
Tatsas, A. D., Owens, C. L., Siddiqui, M. T., Hruban, R. H. and Ali, S. Z. (2012), Fine-needle aspiration of intrapancreatic accessory spleen: Cytomorphologic features and differential diagnosis. Cancer Cytopathology, 120: 261–268. doi: 10.1002/cncy.21185
- Issue published online: 6 AUG 2012
- Article first published online: 1 FEB 2012
- Manuscript Accepted: 23 NOV 2011
- Manuscript Revised: 16 NOV 2011
- Manuscript Received: 6 SEP 2011
- intrapancreatic accessory spleen;
- fine-needle aspiration;
- endoscopic ultrasound;
- epidermoid cyst
Intrapancreatic accessory spleen (IPAS) is a rare benign lesion of the pancreas that frequently clinically and radiographically mimics a solid neoplasm. Very rarely, epidermoid cysts may form in IPAS and be mistaken for a cystic neoplasm of the pancreas on radiographic imaging. IPAS and epidermoid cyst involving intrapancreatic cyst (ECIPAS) are benign, and, if recognized, do not require surgical intervention. There are few reports of the cytopathologic features of IPAS diagnosed by fine-needle aspiration (FNA).
Here we report a series of 6 cases of endoscopic ultrasound (EUS)-guided FNA of IPAS, 3 of which had histological confirmation, including 1 case of histologically confirmed ECIPAS.
Cytomorphologic features of IPAS include a polymorphous population of hematopoietic cells, including lymphocytes, eosinophils, histiocytes, plasma cells, and red blood cells, admixed with numerous small blood vessels representing splenic sinusoids. CD8 immunostaining of cell block or core biopsy material highlights splenic endothelial cells and confirms the diagnosis. FNA of ECIPAS reveals predominantly macrophages and proteinaceous debris.
Diagnostic pitfalls include pancreatic neuroendocrine tumor. If IPAS is recognized as a diagnostic consideration on EUS-FNA, unnecessary surgical resection may be avoided. Cancer (Cancer Cytopathol) 2012. © 2012 American Cancer Society.