Role of endoscopic ultrasound-guided-fine needle aspiration biopsy in the diagnosis of lymphoma of the pancreas: A clinicopathological study of nine cases.
Endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) is an established first-line procedure in the management of solid and cystic pancreatic masses. Lymphoma is an uncommon diagnosis in EUS-FNA of the pancreas, and it is more common for such a diagnosis to be because of secondary involvement of the pancreas by a lymphoproliferative disorder than for this to represent isolated primary pancreatic lymphoma (PPL). We present the clinical, EUS and cytological features of these lesions.
After obtaining approval from our Institutional Review Board (IRB), nine cases of lymphoma diagnosed on EUS-FNA at a tertiary care cancer centre over a period of 8 years from 2008 to 2016 were retrieved from our endoscopy and pathology archives. Rapid onsite evaluation (ROSE) was carried out by a trained cytopathologist in all these cases. Cell blocks were available in seven cases, and immunophenotyping was performed on cell blocks using the immunoperoxidase method. Flow cytometry was performed in two cases.
The most frequent site of involvement was the head of the pancreas (n=5, 55.6%). Four out of nine cases were diagnosed as PPL (44.4%). Five cases were diagnosed as lymphoma secondarily involving the pancreas (55.6%). The most frequent diagnosis was diffuse large B-cell lymphoma (n=6, 66.7%), followed by Hodgkin's lymphoma (n=2, 22.2%) and peripheral T-cell lymphoma (n=1, 11.1%).
EUS-FNA in experienced hands is a valuable diagnostic modality, in conjunction with ROSE, immunohistochemistry and flow cytometry, in the diagnosis and sub-typing of both primary and secondary pancreatic lymphoma.
Sadaf S
，Loya A
，Akhtar N
，Yusuf MA
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Primary pancreatic diffuse large B-cell lymphoma diagnosed by endoscopic ultrasound guided FNAC: A rare entity.
Primary pancreatic lymphoma (PPL) is an uncommon neoplasm which can clinico-radiologically mimic carcinoma. But the management of these patients differs from that of a carcinoma. Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) serves as a potential tool to identify pancreatic lymphomas and thus prevent an invasive diagnostic test. This case report describes the presentation and diagnosis of primary pancreatic lymphoma. A 37-year-old female presented with nausea, vomiting with signs of icterus and elevated liver function test and Bilirubin. Abdominal computed tomography (CT) revealed a hypodense lesion in the head of the pancreas. EUS guided FNA was performed and cytological material was collected. The lesion was diagnosed as Non-Hodgkin Lymphoma (NHL) and subtyped as diffuse large B-cell lymphoma-germinal centre (DLBCL-GCB) base on immunohistochemistry on cell block. The patient was started on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (RCHOP) regimen. EUS guided FNA along with ROSE, cell bock, and immunocytochemistry helps in the diagnosis of primary pancreatic lymphoma.
Ravi S
，Stephen SN
，Gochhait D
，Potakkat B
，Niranjani R
，Siddaraju N
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Onsite cytopathology evaluation and ancillary studies beneficial in EUS-FNA of pancreatic, mediastinal, intra-abdominal, and submucosal lesions.
Endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNA) is considered to be a minimally invasive and safe technique, with low complication rates, for obtaining tissue samples from pancreatic lesions, and mediastinal and intra-abdominal nodes. We retrospectively reviewed the diagnostic accuracy of this method at a tertiary care hospital in Pakistan.
The medical records of 393 consecutive patients referred to the gastroenterology service from August 2008 to September 2013 were reviewed in this retrospective study. The mean age of the patients at presentation was 51.2 years (range 6-89; 56.7% males). Major indications for referral were to establish a diagnosis in patients with a pancreatic mass or lymphadenopathy of unknown origin detected on CT scan or PET-CT (n = 235), to exclude lymph node metastasis in those with a known primary tumor (n = 114), and to rule out relapse of lymphoma after treatment or during follow up (n = 44). Of 393 patients, 181 had mediastinal lymphadenopathy, 115 had pancreatic lesions; 79 had intra-abdominal lymphadenopathy and 18 patients had miscellaneous lesions (gastric mass, splenic, retroperitoneal, esophageal, or adrenal lesions).
A mean of 2.2 passes per patient were made; 85% of patients had ≤ 3 passes. The initial rapid onsite evaluation (ROSE) was positive in 363 of 393 (92.3%) patients, but on final cytopathological interpretation, 369 of 393 (93.9%) patients had an adequate specimen for diagnosis. Sufficient material for cytopathology was obtained in 369 patients (93.9%), whereas 24 patients (6.1%) had inadequate aspirate on EUS-FNA as assessed by final cytopathological interpretation. The concordance between final cytopathological diagnoses and ROSE was 98.2%. Follow-up data were available for 296 (75.3%) patients, whereas 97 patients were lost to follow up. Of these 296 patients, 283 of 296 patients were true positive, 9 of 296 were true negative, and 4 of 296 patients were false negative. The overall calculated sensitivity, specificity, positive predictive value, and negative predictive value were 98.6, 100, 100, and 69.2%, respectively. The major diagnoses that we obtained were granulomata (n = 114), adenocarcinoma (n = 104), reactive nodes (n = 35), metastatic carcinoma (n = 35), Hodgkin's lymphoma (HL; n = 19) and non-Hodgkin's lymphoma (NHL; n = 11), neuroendocrine tumors (n = 11), spindle cell lesions (n = 7), benign lesions (n = 9), cystic neoplasms (n = 6), solid pseudopapillary neoplasm (n = 3), and miscellaneous (n = 15). Only 3 of 393 patients (0.7%) suffered a complication as a result of EUS-FNA, and all three were successfully managed conservatively.
EUS-FNA, combined with ROSE, is a safe and highly effective technique in experienced hands with excellent diagnostic accuracy and low complication rates.
Mehmood S
，Jahan A
，Loya A
，Yusuf MA
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