Pub Date : 2015-11-01DOI: 10.1097/PCR.0000000000000113
E. Turbat-Herrera
Abstract Kidney changes seen in end-stage renal disease, after a period of chronic progressive renal disease, may to give rise to different benign and malignant epithelial proliferative lesions. These epithelial proliferations are many times associated with dialysis, but not necessarily so. Many of these lesions are part and parcel of acquired cystic kidney disease. These may also happen without prior cystic changes. A review of the literature is presented, and the different proliferative lesions discussed. Lesions such as hyperplasia of the Bowman capsule classified as embryonal because of the primitive appearance of the cells, which may or may not form tubular structures, are described. Lesions such as unusual epithelial proliferations within the lining of cysts and endothelial and granular metaplasia noted in patients with hypertension where a hyperplasia of renin-producing cells is seen in the juxtaglomerular apparatus are covered in this article. Patients with end-stage renal disease, especially those on dialysis, can develop acquired cystic kidney disease, and some of the cysts can exhibit atypical epithelial proliferations with multiple layers and pseudopapillary formations. Neoplasms whether benign or malignant are also associated with end-stage kidney disease; these seems to have a predominance of papillary neoplasms, which occur more often than in sporadic tumors. Although these tumors, for the most part, share similar histological appearance with the sporadic ones, these have different molecular imprints.
{"title":"Proliferative Epithelial Lesions Associated With End-Stage Renal Disease","authors":"E. Turbat-Herrera","doi":"10.1097/PCR.0000000000000113","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000113","url":null,"abstract":"Abstract Kidney changes seen in end-stage renal disease, after a period of chronic progressive renal disease, may to give rise to different benign and malignant epithelial proliferative lesions. These epithelial proliferations are many times associated with dialysis, but not necessarily so. Many of these lesions are part and parcel of acquired cystic kidney disease. These may also happen without prior cystic changes. A review of the literature is presented, and the different proliferative lesions discussed. Lesions such as hyperplasia of the Bowman capsule classified as embryonal because of the primitive appearance of the cells, which may or may not form tubular structures, are described. Lesions such as unusual epithelial proliferations within the lining of cysts and endothelial and granular metaplasia noted in patients with hypertension where a hyperplasia of renin-producing cells is seen in the juxtaglomerular apparatus are covered in this article. Patients with end-stage renal disease, especially those on dialysis, can develop acquired cystic kidney disease, and some of the cysts can exhibit atypical epithelial proliferations with multiple layers and pseudopapillary formations. Neoplasms whether benign or malignant are also associated with end-stage kidney disease; these seems to have a predominance of papillary neoplasms, which occur more often than in sporadic tumors. Although these tumors, for the most part, share similar histological appearance with the sporadic ones, these have different molecular imprints.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-01DOI: 10.1097/PCR.0000000000000117
G. Herrera
Abstract There are many types of cystic renal diseases, each with specific clinical and morphologic correlates, genetics, and clinical behavior and prognosis. This article addresses the important facts that are characteristic of each of the cystic conditions in the kidney to provide criteria to allow their accurate diagnosis.
{"title":"Cystic Renal Diseases: A Primer for Diagnosing and Understanding These Disorders","authors":"G. Herrera","doi":"10.1097/PCR.0000000000000117","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000117","url":null,"abstract":"Abstract There are many types of cystic renal diseases, each with specific clinical and morphologic correlates, genetics, and clinical behavior and prognosis. This article addresses the important facts that are characteristic of each of the cystic conditions in the kidney to provide criteria to allow their accurate diagnosis.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-01DOI: 10.1097/PCR.0000000000000120
G. Herrera
Abstract The severe shortage of kidneys for transplantation has led efforts to expand the kidney donor pool, and to accomplish this goal, kidneys from expanded-criteria donors are being considered today for transplantation. Despite the frequent use of pretransplant biopsies of donor kidneys, no consensus has been reached regarding the prognostic significance of the various pathologic findings. The pathologic evaluation is focused on determining the percentage of globally sclerosed glomeruli; degree of interstitial fibrosis; arteriolar and arterial damage, including degree of vessel wall thickening and the presence/absence of vascular thrombosis; and identifying “significant” glomerular, inflammatory tubulointerstitial or vascular pathology. This information is provided to the transplant surgeon who then makes a determination of whether to transplant or not the deceased- or living-donor kidney in question, if any or a combination of the previously mentioned findings is identified. The present article describes how these donor kidneys should be evaluated morphologically and the impact of the various findings that may be found in deciding whether the kidney should be transplanted and addresses prognostic issues related to transplantation of kidneys exhibiting some of the previously mentioned findings not deemed to be severe enough to prevent transplantation. A review of the different criteria and systems that have been used in the past will be provided to understand how the evaluation process has been viewed by various investigators and the relationship of the various findings to immediate function and prognosis of the grafts. This information is important for surgical pathologists who may be asked to do frozen sections in these kidneys before transplant and/or sign out these specimens in their practices.
{"title":"Evaluating Donor Kidneys for Transplantation: What to Look for and How to Compile a Meaningful Report","authors":"G. Herrera","doi":"10.1097/PCR.0000000000000120","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000120","url":null,"abstract":"Abstract The severe shortage of kidneys for transplantation has led efforts to expand the kidney donor pool, and to accomplish this goal, kidneys from expanded-criteria donors are being considered today for transplantation. Despite the frequent use of pretransplant biopsies of donor kidneys, no consensus has been reached regarding the prognostic significance of the various pathologic findings. The pathologic evaluation is focused on determining the percentage of globally sclerosed glomeruli; degree of interstitial fibrosis; arteriolar and arterial damage, including degree of vessel wall thickening and the presence/absence of vascular thrombosis; and identifying “significant” glomerular, inflammatory tubulointerstitial or vascular pathology. This information is provided to the transplant surgeon who then makes a determination of whether to transplant or not the deceased- or living-donor kidney in question, if any or a combination of the previously mentioned findings is identified. The present article describes how these donor kidneys should be evaluated morphologically and the impact of the various findings that may be found in deciding whether the kidney should be transplanted and addresses prognostic issues related to transplantation of kidneys exhibiting some of the previously mentioned findings not deemed to be severe enough to prevent transplantation. A review of the different criteria and systems that have been used in the past will be provided to understand how the evaluation process has been viewed by various investigators and the relationship of the various findings to immediate function and prognosis of the grafts. This information is important for surgical pathologists who may be asked to do frozen sections in these kidneys before transplant and/or sign out these specimens in their practices.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-01DOI: 10.1097/PCR.0000000000000112
J. Aufman
Abstract Needle core biopsy is an important procedure used to evaluate transplanted kidneys. By examining the morphological findings, the pathologist can inform the nephrologist of certain findings that help guide the therapeutic management to prolong the life of the transplant kidney. The request for a kidney biopsy is usually decided as soon as signs and symptoms of renal dysfunction are noticed by the nephrologist, and therefore, most biopsies of the transplanted kidneys usually have some type of morphological pathology, which may be minimal because of the acute awareness of early rejection. This review discusses the history of acute antibody-mediated rejection and the morphological findings seen in humor rejection of the transplanted kidney.
{"title":"Transplant Kidney With Acute Humoral Rejection Diagnosed by Needle Core Biopsy—A Case Report With Review of Pathological Morphology","authors":"J. Aufman","doi":"10.1097/PCR.0000000000000112","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000112","url":null,"abstract":"Abstract Needle core biopsy is an important procedure used to evaluate transplanted kidneys. By examining the morphological findings, the pathologist can inform the nephrologist of certain findings that help guide the therapeutic management to prolong the life of the transplant kidney. The request for a kidney biopsy is usually decided as soon as signs and symptoms of renal dysfunction are noticed by the nephrologist, and therefore, most biopsies of the transplanted kidneys usually have some type of morphological pathology, which may be minimal because of the acute awareness of early rejection. This review discusses the history of acute antibody-mediated rejection and the morphological findings seen in humor rejection of the transplanted kidney.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000112","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-01DOI: 10.1097/PCR.0000000000000114
J. Aufman
Abstract This article shows the evolving history of the Banff classification for allograft biopsies and gives helpful clues on properly diagnosing each classification. In today’s pathology practice, a general pathologist who does not regularly sign out many transplant kidney cases may be unsure of the details that the nephrologist may need to know for proper patient treatment. This article also discusses the latest Banff classification and the differential diagnoses one may encounter when diagnosing an allograft biopsy.
{"title":"What a Nonnephropathologist Must Know About Kidney Rejection","authors":"J. Aufman","doi":"10.1097/PCR.0000000000000114","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000114","url":null,"abstract":"Abstract This article shows the evolving history of the Banff classification for allograft biopsies and gives helpful clues on properly diagnosing each classification. In today’s pathology practice, a general pathologist who does not regularly sign out many transplant kidney cases may be unsure of the details that the nephrologist may need to know for proper patient treatment. This article also discusses the latest Banff classification and the differential diagnoses one may encounter when diagnosing an allograft biopsy.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-01DOI: 10.1097/PCR.0000000000000121
Firas Al-Delfi, G. Herrera
This is a case report of a 63-year-old morbidly obese (body mass index, 46.5 kg/m2) African American woman with a medical history of recurrent urinary tract infections, diverticulosis/diverticulitis, duodenitis, colovesical fistula, gout, hypertension, degenerative joint disease, carpal tunnel syndrome, a 20-pack-year history of tobacco use, and bilateral axillary hidradenitis suppurativa. After multiple episodes of gross hematuria and suprapubic discomfort, a computed tomographic scan showed a solid mass in the lower pole of the right kidney. The patient underwent right open radical nephrectomy in May 2010 without major complications. A conventional (clear cell) renal cell carcinoma and a small papillary renal cell carcinoma were found upon histopathologic examination of the kidney. Examination of the nonneoplastic renal parenchyma revealed changes indicative of focal segmental glomerulosclerosis, as well as mild arterial nephrosclerosis. No tumor metastases were detected at 5 years after nephrectomy. Her serum creatinine and estimated glomerular filtration rate gradually deteriorated in the 5 years after nephrectomy. The gradual, less steep renal function deterioration of this patient emphasizes the importance of reporting nonneoplastic renal lesions/diseases in nephrectomies for kidney and renal pelvis tumors. She developed edema, progressive proteinuria reaching 6.5 g/d, and serum creatinine level of 4.2 mg/dL (baseline serum creatinine at time of nephrectomy was 0.7 mg/dL). The early diagnosis helped medically manage and delay the progression of the medical renal disorder. An easy algorithmic approach for nonneoplastic renal parenchymal tissue should be adopted by general/surgical pathologists when evaluating surgical nephrectomies.
{"title":"Conventional and Papillary Renal Cell Carcinomas and Focal Segmental Glomerulosclerosis in a Nephrectomy","authors":"Firas Al-Delfi, G. Herrera","doi":"10.1097/PCR.0000000000000121","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000121","url":null,"abstract":"This is a case report of a 63-year-old morbidly obese (body mass index, 46.5 kg/m2) African American woman with a medical history of recurrent urinary tract infections, diverticulosis/diverticulitis, duodenitis, colovesical fistula, gout, hypertension, degenerative joint disease, carpal tunnel syndrome, a 20-pack-year history of tobacco use, and bilateral axillary hidradenitis suppurativa. After multiple episodes of gross hematuria and suprapubic discomfort, a computed tomographic scan showed a solid mass in the lower pole of the right kidney. The patient underwent right open radical nephrectomy in May 2010 without major complications. A conventional (clear cell) renal cell carcinoma and a small papillary renal cell carcinoma were found upon histopathologic examination of the kidney. Examination of the nonneoplastic renal parenchyma revealed changes indicative of focal segmental glomerulosclerosis, as well as mild arterial nephrosclerosis. No tumor metastases were detected at 5 years after nephrectomy. Her serum creatinine and estimated glomerular filtration rate gradually deteriorated in the 5 years after nephrectomy. The gradual, less steep renal function deterioration of this patient emphasizes the importance of reporting nonneoplastic renal lesions/diseases in nephrectomies for kidney and renal pelvis tumors. She developed edema, progressive proteinuria reaching 6.5 g/d, and serum creatinine level of 4.2 mg/dL (baseline serum creatinine at time of nephrectomy was 0.7 mg/dL). The early diagnosis helped medically manage and delay the progression of the medical renal disorder. An easy algorithmic approach for nonneoplastic renal parenchymal tissue should be adopted by general/surgical pathologists when evaluating surgical nephrectomies.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.1097/PCR.0000000000000105
J. Hipp, Syed Z. Ali, C. VandenBussche
Abstract Poorly differentiated thyroid carcinoma (PDTC) is a distinct entity of thyroid follicular origin (without follicular or papillary differentiation), with high-grade features and an aggressive clinical behavior intermediate between that of well-differentiated and undifferentiated thyroid carcinoma. It accounts for 4% to 7% of thyroid malignancies. Poorly differentiated thyroid carcinoma often presents at an advanced stage and tends to metastasize to regional lymph nodes, lungs, and bones. A variety of histological patterns exists for PDTC and the corresponding cytomorphological features are also varied and depend on the growth pattern of the individual neoplasm. We report the cytomorphology of PDTC sampled by fine-needle aspiration and review previously reported cases in the literature. While PDTC do not possess specific cytomorphological features that would allow for a definitive diagnosis on fine-needle aspiration, the presence of certain features may suggest the possibility of this rare neoplasm. In particular, cells with overlapping bland nuclei found both in groups and individually are common features. Lesions are often cellular and lack colloid, providing the sense of a neoplasm. It may be difficult to exclude the more common possibility of a papillary thyroid carcinoma or follicular neoplasm; however, familiarity with this uncommon entity allows one to include it in the differential diagnosis.
{"title":"Poorly Differentiated (“Insular”) Thyroid Carcinoma on Fine-Needle Aspiration","authors":"J. Hipp, Syed Z. Ali, C. VandenBussche","doi":"10.1097/PCR.0000000000000105","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000105","url":null,"abstract":"Abstract Poorly differentiated thyroid carcinoma (PDTC) is a distinct entity of thyroid follicular origin (without follicular or papillary differentiation), with high-grade features and an aggressive clinical behavior intermediate between that of well-differentiated and undifferentiated thyroid carcinoma. It accounts for 4% to 7% of thyroid malignancies. Poorly differentiated thyroid carcinoma often presents at an advanced stage and tends to metastasize to regional lymph nodes, lungs, and bones. A variety of histological patterns exists for PDTC and the corresponding cytomorphological features are also varied and depend on the growth pattern of the individual neoplasm. We report the cytomorphology of PDTC sampled by fine-needle aspiration and review previously reported cases in the literature. While PDTC do not possess specific cytomorphological features that would allow for a definitive diagnosis on fine-needle aspiration, the presence of certain features may suggest the possibility of this rare neoplasm. In particular, cells with overlapping bland nuclei found both in groups and individually are common features. Lesions are often cellular and lack colloid, providing the sense of a neoplasm. It may be difficult to exclude the more common possibility of a papillary thyroid carcinoma or follicular neoplasm; however, familiarity with this uncommon entity allows one to include it in the differential diagnosis.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.1097/PCR.0000000000000107
L. Goicochea, Paul N. Staats
Abstract Anaplastic, or undifferentiated, thyroid carcinoma (ATC) is a highly aggressive disease with less than 1-year survival in nearly all patients with this disease. Because of its aggressive nature, ATC is frequently unresectable. Rapid and accurate pretreatment diagnosis is required to attempt local-regional control. Fine-needle aspiration (FNA) and core-needle biopsy (CNB) are the most widely used initial means of obtaining a tissue diagnosis of this entity, and these specimens are often the only tissue procured before definitive therapy. Although the literature on cytologic diagnosis of ATC is limited, the performance characteristics of FNA appear to be good, with high sensitivity and specificity. However, diagnosis can be challenging because of the variable appearance of aspirated cells of ATC and a broad differential diagnosis that includes medullary carcinoma, poorly differentiated thyroid carcinoma, lymphoma, primary thyroid sarcoma, and metastatic tumors. The use of a limited panel of immunohistochemical stains is often helpful in distinguishing these entities. Although ATC arises in many cases from a well-differentiated thyroid carcinoma, the limited nature of an FNA or CNB specimen usually precludes identification of an associated lower-grade lesion. Herein, we report a case of ATC diagnosed on FNA and CNB and review the diagnosis of ATC from a cytopathology perspective.
{"title":"Anaplastic Thyroid Carcinoma, a Cytologic Perspective: Case Report and Review of Anaplastic Thyroid Carcinoma","authors":"L. Goicochea, Paul N. Staats","doi":"10.1097/PCR.0000000000000107","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000107","url":null,"abstract":"Abstract Anaplastic, or undifferentiated, thyroid carcinoma (ATC) is a highly aggressive disease with less than 1-year survival in nearly all patients with this disease. Because of its aggressive nature, ATC is frequently unresectable. Rapid and accurate pretreatment diagnosis is required to attempt local-regional control. Fine-needle aspiration (FNA) and core-needle biopsy (CNB) are the most widely used initial means of obtaining a tissue diagnosis of this entity, and these specimens are often the only tissue procured before definitive therapy. Although the literature on cytologic diagnosis of ATC is limited, the performance characteristics of FNA appear to be good, with high sensitivity and specificity. However, diagnosis can be challenging because of the variable appearance of aspirated cells of ATC and a broad differential diagnosis that includes medullary carcinoma, poorly differentiated thyroid carcinoma, lymphoma, primary thyroid sarcoma, and metastatic tumors. The use of a limited panel of immunohistochemical stains is often helpful in distinguishing these entities. Although ATC arises in many cases from a well-differentiated thyroid carcinoma, the limited nature of an FNA or CNB specimen usually precludes identification of an associated lower-grade lesion. Herein, we report a case of ATC diagnosed on FNA and CNB and review the diagnosis of ATC from a cytopathology perspective.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-01DOI: 10.1097/PCR.0000000000000096
W. Foo, K. Youens, P. Jowell, S. Bean
Background Endoscopic ultrasound–guided fine-needle aspiration (FNA) has become a well-established diagnostic method for evaluation of focal lesions in the pancreas. While the majority of malignant lesions evaluated are primary pancreatic adenocarcinomas, rarely, metastatic lesions to the pancreas are discovered, altering treatment and prognosis for patients. In this retrospective case series study, we describe the 22-year experience with cytologic diagnosis of secondary pancreatic neoplasms in a tertiary medical center. Methods A search of the electronic pathology database at Duke University Medical Center was performed to identify all patients who had image-guided FNA biopsy of the pancreas diagnosed with secondary neoplasms from 1990 to 2012. Clinical information including sex, age, prior history of malignancy, imaging features of pancreatic mass(es), cytology diagnosis, treatment, and survival was collected. Descriptive statistics were performed. Results Fifty-three patients had a secondary malignancy of the pancreas from 11 primary sites diagnosed on FNA. The most common primary site was hematopoietic (36%), followed by renal (19%), melanocytic (11%), pulmonary (11%), ovarian (6%), breast (4%), esophageal (4%), and soft tissue (4%). Colorectal (2%), prostatic (2%), and nasopharyngeal (2%) metastases were also identified. No specific imaging features reliably differentiated secondary lesions from primary lesions. The majority of patients (75%) had a prior history of malignancy. Of those without a prior history of malignancy, greater than 90% had a secondary malignancy of hematopoietic origin. Conclusions Cytologic diagnosis of secondary pancreatic neoplasms is rare. The most common secondary neoplasm of the pancreas was of hematopoietic origin. Imaging characteristics of secondary neoplasms are variable and nonspecific.
{"title":"Image-Guided Fine-Needle Aspiration of Secondary Pancreatic Neoplasms: A Case Series and Review of the Literature","authors":"W. Foo, K. Youens, P. Jowell, S. Bean","doi":"10.1097/PCR.0000000000000096","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000096","url":null,"abstract":"Background Endoscopic ultrasound–guided fine-needle aspiration (FNA) has become a well-established diagnostic method for evaluation of focal lesions in the pancreas. While the majority of malignant lesions evaluated are primary pancreatic adenocarcinomas, rarely, metastatic lesions to the pancreas are discovered, altering treatment and prognosis for patients. In this retrospective case series study, we describe the 22-year experience with cytologic diagnosis of secondary pancreatic neoplasms in a tertiary medical center. Methods A search of the electronic pathology database at Duke University Medical Center was performed to identify all patients who had image-guided FNA biopsy of the pancreas diagnosed with secondary neoplasms from 1990 to 2012. Clinical information including sex, age, prior history of malignancy, imaging features of pancreatic mass(es), cytology diagnosis, treatment, and survival was collected. Descriptive statistics were performed. Results Fifty-three patients had a secondary malignancy of the pancreas from 11 primary sites diagnosed on FNA. The most common primary site was hematopoietic (36%), followed by renal (19%), melanocytic (11%), pulmonary (11%), ovarian (6%), breast (4%), esophageal (4%), and soft tissue (4%). Colorectal (2%), prostatic (2%), and nasopharyngeal (2%) metastases were also identified. No specific imaging features reliably differentiated secondary lesions from primary lesions. The majority of patients (75%) had a prior history of malignancy. Of those without a prior history of malignancy, greater than 90% had a secondary malignancy of hematopoietic origin. Conclusions Cytologic diagnosis of secondary pancreatic neoplasms is rare. The most common secondary neoplasm of the pancreas was of hematopoietic origin. Imaging characteristics of secondary neoplasms are variable and nonspecific.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000096","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-07-01DOI: 10.1097/PCR.0000000000000098
F. Mukhtar, J. Levesque, Shantel Hébert‐Magee, A. Nunez, I. Eltoum
Background Primary small cell carcinoma (SCC) of the pancreas is rare, approximately 35 cases reported in the literature. The aim of this study was to review a large center experience with SCC and determine whether the tumor was primary or metastatic. Methods In this retrospective correlation study, we reviewed electronic medical records and cytology and histology reports of all endoscopic ultrasonography–guided fine-needle aspiration of the pancreas between 2000 and 2010 to identify cases diagnosed as SCC of the pancreas. We determined if lesions were primary or metastatic based on patient history, imaging, and pathologic findings. Metastasis was considered when the patient concurrently or previously had a mass elsewhere as well as immunohistochemical stains supporting the tumor origin. Results Two thousand four hundred forty-five pancreatic fine-needle aspirations were identified during the study period (2000–2010). One hundred thirty-four of 2445 cases were endocrine neoplasms, with 8 patients (6%) identified as SCC (poorly differentiated endocrine carcinoma). Five patients had primary lung carcinoma, and 1 patient had primary cervical SCC, whereas a primary lesion could not be identified in the other 2. The prevalence of SCC was 1.5% of all endocrine neoplasms. Cytologic features and endocrine markers were diagnostic of SCC in all patients. All but 1 patient died, survival ranging from 5 to 32 months (median, 11 months) after the diagnosis. Conclusions Pancreatic SCC is rare and carries a grave prognosis. Most pancreatic SCCs are metastatic; therefore, search for the primary tumor is required, particularly given recent reports of good response of primary SCC to surgical resection.
{"title":"Small Cell Carcinoma of the Pancreas: Primary or Metastatic?","authors":"F. Mukhtar, J. Levesque, Shantel Hébert‐Magee, A. Nunez, I. Eltoum","doi":"10.1097/PCR.0000000000000098","DOIUrl":"https://doi.org/10.1097/PCR.0000000000000098","url":null,"abstract":"Background Primary small cell carcinoma (SCC) of the pancreas is rare, approximately 35 cases reported in the literature. The aim of this study was to review a large center experience with SCC and determine whether the tumor was primary or metastatic. Methods In this retrospective correlation study, we reviewed electronic medical records and cytology and histology reports of all endoscopic ultrasonography–guided fine-needle aspiration of the pancreas between 2000 and 2010 to identify cases diagnosed as SCC of the pancreas. We determined if lesions were primary or metastatic based on patient history, imaging, and pathologic findings. Metastasis was considered when the patient concurrently or previously had a mass elsewhere as well as immunohistochemical stains supporting the tumor origin. Results Two thousand four hundred forty-five pancreatic fine-needle aspirations were identified during the study period (2000–2010). One hundred thirty-four of 2445 cases were endocrine neoplasms, with 8 patients (6%) identified as SCC (poorly differentiated endocrine carcinoma). Five patients had primary lung carcinoma, and 1 patient had primary cervical SCC, whereas a primary lesion could not be identified in the other 2. The prevalence of SCC was 1.5% of all endocrine neoplasms. Cytologic features and endocrine markers were diagnostic of SCC in all patients. All but 1 patient died, survival ranging from 5 to 32 months (median, 11 months) after the diagnosis. Conclusions Pancreatic SCC is rare and carries a grave prognosis. Most pancreatic SCCs are metastatic; therefore, search for the primary tumor is required, particularly given recent reports of good response of primary SCC to surgical resection.","PeriodicalId":43475,"journal":{"name":"AJSP-Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/PCR.0000000000000098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61757426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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