Cytopathology Case 12

EUS-Guided Fine Needle Aspiration of a 46 year old Female with a Pancreatic Mass

by Benjamin L. Witt, MD, Clinical Instructor of Pathology, University of Utah, and Medical Director, Cytopathology, ARUP Laboratories
and Doug G. Adler, MD, Associate Professor, Department of Internal Medicine, University of Utah School of Medicine

Editor: Benjamin L. Witt, MD, Clinical Instructor of Pathology, University of Utah, and Medical Director, Cytopathology, ARUP Laboratories

The patient is a 46 year-old female with a noncontributory past medical history who underwent an abdominal CT scan for the evaluation of her longstanding hypertension. Upon CT imaging she was incidentally found to have a 5.3 x 4.0 x 3.1 cm mixed solid/cystic mass in the body of the pancreas. The mass did not appear to involve the surrounding vasculature and there was no associated pancreatic or biliary ductal dilatation. Shortly thereafter, an endoscopic ultrasound-guided fine needle aspiration was performed on the pancreatic mass.

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Cytomorphology Description:

Microscopic Features:

  • A monotonous cellular proliferation with a somewhat papillary architechture(fig. 1)
  • The monotonous cell proliferation demonstrates both cohesive and dispersed patterns(fig. 2).
  • The cells are intermediate in size, have a moderate amount of cytoplasm, show occasional plasmacytoid forms, and seem to fall off of a vague vascular core(fig. 3).
  • Higher power of the vague vascular core showing a central metachromatic matrix(fig. 4).
  • Β-catenin showing nuclear and cytoplasmic positivity in the cells of interest(fig. 5).
  • Low power (H&E) of the excised tumor showing solid and cystic-like areas(fig. 6).
  • (H&E) highlighting the hyalinized perivascular material and loosely cohesive monotonous tumor cell proliferation(fig. 7).
  • High power (H&E) showing neoplastic cells resembling those on cytology smears(fig. 8).

Final Diagnosis & Discussion

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