Fine-needle aspiration of intrapancreatic accessory spleen: Cytomorphologic features and differential diagnosis

Authors

  • Armanda D. Tatsas MD,

    Corresponding author
    1. Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Hospital, Baltimore, Maryland
    • Department of Pathology, The Johns Hopkins Hospital, PATH 406, 600 North Wolfe Street, Baltimore, MD 21287

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    • Fax: (410) 614-9556

  • Christopher L. Owens MD,

    1. Department of Pathology, University of Massachusetts, Worcester, Massachusetts
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  • Momin T. Siddiqui MD,

    1. Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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  • Ralph H. Hruban MD,

    1. Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Hospital, Baltimore, Maryland
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  • Syed Z. Ali MD

    1. Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Hospital, Baltimore, Maryland
    2. Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Hospital, Baltimore, Maryland
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Abstract

BACKGROUND:

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).

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

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