The Value of Cellblock in Diagnosing Pancreatic Lymphomas.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the diagnostic tool of choice for pancreatic solid mass lesions. Pancreatic lymphomas represent an infrequent and challenging cytologic diagnosis. Our aim was to determine the diagnostic value of cellblock (CB) in the diagnosis of pancreatic lymphomas. We retrieved pancreatic EUS-FNAs performed over 10-years from our institution's database. We correlated the cytologic and CB diagnosis with the histologic diagnosis as a gold standard. We found 5 cases (2 women and 3 men; age range, 37-66 years [average age, 52 years]) of pancreatic lymphomas with histologic follow-up biopsies. They included 1 case of T-cell lymphoma (TCL), 1 case of plasma cell neoplasm (multiple myeloma [MM]), 1 case of diffuse large B-cell lymphoma (DLBCL), 1 case of classic Hodgkin lymphoma (HL), and 1 case of high-grade B-cell lymphoma (HGBCL). Cytologically, the cases of HL and DLBCL were suspected, the cases of TCL and MM were confused with undifferentiated carcinoma and neuroendocrine carcinoma, and the case of HGBCL was inconclusive. CB samples were of value in highlighting the morphologic details of lymphomas and allowed confirmation, proper classification, and grading of the lymphomas using immunohistochemistry that matched tissue biopsies. EUS-FNA smears with CBs are helpful diagnostic tools, differentiating lymphomas from other malignancies and from nonneoplastic lymphocyte-rich lesions. CBs allow proper classification and grading of cases of pancreatic lymphomas.

AbdullGaffar B ，Hotait H 《-》

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 ... -  《-》

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 ... -  《-》

Touch imprint cytology on endoscopic ultrasound fine-needle biopsy provides comparable sample quality and diagnostic yield to standard endoscopic ultrasound fine-needle aspiration specimens in the evaluation of solid pancreatic lesions.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the gold standard for the diagnosis of solid pancreatic lesions (SPLs). Cytological samples can also be obtained using touch imprint cytology (TIC) on EUS fine-needle biopsy (FNB) specimens. We aimed to compare sample quality and diagnostic yield of EUS-FNA-standard cytology (EUS-FNA-SC) to that of EUS-FNB-TIC in a series of patients with SPLs. Thirty-two consecutive patients referred for EUS-tissue acquisition of SPLs who underwent rapid on-site evaluation of both EUS-FNA-SC and paired EUS-FNB-TIC during the same endoscopic session were retrospectively identified. Sample quality (evaluated in terms of blood contamination, presence of clots, tissue casts, cellularity, and necrosis) and diagnostic yield were compared between the techniques. The mean number of passes to reach diagnosis at rapid on-site evaluation was similar between EUS-FNA-SC and EUS-FNB-TIC (1.09 ± 0.3 vs 1.13 ± 0.34, P = .711). EUS-FNA-SC scores of sample quality were comparable to those of EUS-FNB-TIC (blood contamination, 2.47 ± 1.11 vs 2.25 ± 1.14, P = .109; clots, 1.25 ± 0.76 vs 1.19 ± 0.69, P = .624; tissue casts, 3.56 ± 0.88 vs 3.59 ± 1.09, P = .872; cellularity, 2.84 ± 1.11 vs 3.09 ± 1.09, P = .244; necrosis, 2.25 ± 1.08 vs 2.53 ± 1.02 P = .059; total score, 12.38 ± 2.88 vs 17.66 ± 2.38, P = .536). Adequacy, sensitivity and diagnostic accuracy of the two sampling techniques were equal (93.7%, 90.6% and 90.6%, respectively). EUS-FNB-TIC provides comparable samples to those of EUS-FNA-SC and combines the benefits of cytology and histology for the evaluation of SPLs by employing a single needle during the same endoscopic procedure.

Crinò SF ，Larghi A ，Bernardoni L ，Parisi A ，Frulloni L ，Gabbrielli A ，Parcesepe P ，Scarpa A ，Manfrin E ... -  《-》

Diagnostic efficacy of cell block immunohistochemistry, smear cytology, and liquid-based cytology in endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions: a single-institution experience.

Qin SY ，Zhou Y ，Li P ，Jiang HX ... -  《-》