Aspiration cytopathology of peripancreatic space

A clinicoradiologic and cytopathologic analyses of 42 cases

Justin Bishop, Wei Zhang, Olga B. Ioffe, Syed Z. Ali

Research output: Contribution to journalArticle

Abstract

Background: The pancreas is surrounded by soft tissue known as the peripancreatic space (PPS). Pathologic lesions of the PPS are infrequent and have only rarely been reported in the cytopathology literature. Methods: A retrospective review of cytopathology files at two large institutions revealed 42 cases of PPS lesions obtained by transabdominal fine needle aspiration (FNA) or endoscopic ultrasound-guided FNA over a 16-year period. Clinicoradiologic findings and follow-up information were also reviewed. Results: Patients ranged in age from 23-83 years (mean, 60 years) with an equal gender distribution. The major clinical presentations included pain, jaundice, nausea/ vomiting, and abnormal liver enzymes. Radiographic characteristics included lymphadenopathy and cystic/solid soft tissue masses with a size range of 1.5 to 8 cm. Cytologically, 4 (9.5%) cases were nondiagnostic, 9 (21.5%) were diagnosed as benign, 4 (9.5%) were atypical or suspicious for cancer, and 25 (59.5%) were malignant. Six of 25 (24%) patients had metastasis of a prior known malignancy. Conclusions: FNA of PPS masses is a rare occurrence. The majority of lesions are metastatic carcinomas from a variety of primary sites. Flow cytometry and immunoperoxidase studies are useful adjuncts to determine the tumor origin. The sensitivity of PPS aspiration for a malignant diagnosis is 90% with a positive predictive value of 100%.

Original languageEnglish (US)
Pages (from-to)258-264
Number of pages7
JournalKorean Journal of Pathology
Volume47
Issue number3
DOIs
StatePublished - Aug 27 2013

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Fine Needle Biopsy
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Neoplasms
Jaundice
Nausea
Vomiting
Pancreas
Flow Cytometry
Neoplasm Metastasis
Carcinoma
Pain
Liver
Enzymes
Aspirations (Psychology)
Lymphadenopathy

Keywords

  • Adenocarcinoma
  • Cytopathology
  • Fine needle aspiration
  • Peripancreatic space

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Aspiration cytopathology of peripancreatic space : A clinicoradiologic and cytopathologic analyses of 42 cases. / Bishop, Justin; Zhang, Wei; Ioffe, Olga B.; Ali, Syed Z.

In: Korean Journal of Pathology, Vol. 47, No. 3, 27.08.2013, p. 258-264.

Research output: Contribution to journalArticle

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abstract = "Background: The pancreas is surrounded by soft tissue known as the peripancreatic space (PPS). Pathologic lesions of the PPS are infrequent and have only rarely been reported in the cytopathology literature. Methods: A retrospective review of cytopathology files at two large institutions revealed 42 cases of PPS lesions obtained by transabdominal fine needle aspiration (FNA) or endoscopic ultrasound-guided FNA over a 16-year period. Clinicoradiologic findings and follow-up information were also reviewed. Results: Patients ranged in age from 23-83 years (mean, 60 years) with an equal gender distribution. The major clinical presentations included pain, jaundice, nausea/ vomiting, and abnormal liver enzymes. Radiographic characteristics included lymphadenopathy and cystic/solid soft tissue masses with a size range of 1.5 to 8 cm. Cytologically, 4 (9.5{\%}) cases were nondiagnostic, 9 (21.5{\%}) were diagnosed as benign, 4 (9.5{\%}) were atypical or suspicious for cancer, and 25 (59.5{\%}) were malignant. Six of 25 (24{\%}) patients had metastasis of a prior known malignancy. Conclusions: FNA of PPS masses is a rare occurrence. The majority of lesions are metastatic carcinomas from a variety of primary sites. Flow cytometry and immunoperoxidase studies are useful adjuncts to determine the tumor origin. The sensitivity of PPS aspiration for a malignant diagnosis is 90{\%} with a positive predictive value of 100{\%}.",
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