Cytologic features of pancreatic adenocarcinoma with “vacuolated cell pattern.” report of a case diagnosed by endoscopic ultrasound-guided fine-needle aspiration

Authors

  • Arbaz Samad M.D.,

    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
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  • Andrea B. Conway M.D.,

    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
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  • Rajeev Attam M.D.,

    1. Division of Gastroenterology Hepatology and Nutrition, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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  • Jose Jessurun M.D.,

    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
    Current affiliation:
    1. Professor of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
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  • Stefan E. Pambuccian M.D.

    Corresponding author
    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
    Current affiliation:
    1. Professor and Director of Surgical Pathology, Department of Pathology, Loyola University Medical Center, Maywood, IL
    • Correspondence to: Stefan Pambuccian, M.D., Professor, Director of Surgical Pathology, Loyola University Medical Center and Stritch School of Medicine, 2160 S 1st Ave, # 110-2230, Maywood, IL 60153. E-mail: spambuccian@lumc.edu

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Abstract

The “vacuolated cell pattern” has only been recently described as a distinct morphologic variant of pancreatobiliary adenocarcinoma. Herein, we report the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytologic features of a case of pancreatic adenocarcinoma with “vacuolated cell pattern” occurring in a 60-year-old man. The aspirate smears and cell block sections from the EUS-FNA of a 23.5 mm hypoechoic pancreatic head mass were highly cellular, showing variably-sized crowded three-dimensional cell clusters, flat sheets, and numerous highly atypical single cells. The background was bloody and showed necrotic debris, but no discernible mucus. The most striking feature of the aspirate was the presence of numerous very large (20–50 µm) vacuoles, occupying the entire cytoplasm, pushing the nuclei to the side and indenting them, that imparted a cribriform appearance to the sheets of neoplastic cells. The non-vacuolated neoplastic cells were large, had abundant dense (squamoid) cytoplasm, irregularly contoured hyperchromatic nuclei, and prominent macronucleoli. Histologic evaluation of the pancreatectomy specimen showed a “vacuolated cell pattern” adenocarcinoma composed of poorly formed glands, solid sheets, and infiltrating single cells with pleomorphic nuclei and large cytoplasmic vacuoles. To our knowledge, this is the first report describing the cytologic features of this rather uncommon morphologic variant of pancreatic adenocarcinoma. Recognition of this morphologic variant of pancreatic adenocarcinoma in ESU-FNA samples allows its differentiation from primary and metastatic signet-ring cell carcinomas. Diagn. Cytopathol. 2014;42:302–307. © 2014 Wiley Periodicals, Inc.

Ancillary