detection of very well differentiated adenocarcinoma of pancreas
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Detection of very well differentiated adenocarcinoma of pancreas and bile duct epithelium
TOM MENGMarch 24, 2008
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Cytology of biliary tract, including the ampulla of Vater, common bile duct, and pancreatic duct is becoming increasingly important for variety of reasons. Cytological examination cannot only aid in the diagnosis but can spare the patient unnecessary surgery (2,P357).
However, adenocarcinoma of pancreas and bile duct epithelium may be very well differentiated. Sometimes confusion of diagnosis may occur, so distinguishing them from benign has cytological significance.
Features will be presented to help at least diagnose suspicious for adenocarcinoma.
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Bile duct
Normal bile ductal cells:
Cohesive, monolayer sheet of medium-sized columnar or cuboidal cells
Form regular, honeycombing or palisading arrangement
Nuclei are round to oval with smooth nuclear membranes
Fine, evenly distributed chromatin
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Normal bile duct cells
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Normal bile duct cells
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W.D. Adenocarcinoma of bile duct:
May be extremely well differentiated, so any change from normal may be suspicious such as:
Loss of polarity OverlappingCluster or 3-D ballIncreased N/C ratio Slight nuclear enlargementSlight nuclear membrane irregularitiesSlight hyperchromasiaProminent nucleoli
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AdenocarcinomaOf bile duct
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Benign
Malignant
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AdenocarcinomaOf bile duct
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AdenocarcinomaOf bile duct
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Pancreas
Normal pancreatic ductal cells
The cells of the pancreatic duct and bile duct are cytologically similar(2 P358):
Cuboidal to columnar cells, rare to see ciliaMonolayer groups usually honeycombing or picket fencing
Round or oval basally located nuclei Evenly distributed, finely granular chromatinSmooth nuclear membranes
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Normal pancreaticDuctal cells
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Pancreatic Adenocarcinoma
May be extremely well differentiated, so any change from normal may be suspicious such as:
Overlapping nucleiClusters or 3-D ballLoss of polarityIncreased N/C ratioSlight nuclear enlargementSlight hyperchromasia
Slight nuclear membrane irregularitiesProminent nucleoli
May see cytoplasmic vacuolization and mitoses
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Adenocarcinoma of pancreas
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Adenocarcinoma of pancreas
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Adenocarcinoma of pancreas
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Adenocarcinoma of pancreas
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ProstateAdenocarcinoma of three sites may be very well
differentiated: pancreas, bile duct, and prostate. Diagnosis of prostatic FNA is similar to pancreas and bile duct. Helpful in prostate cytology is the presence of branching and bridging structures = very suspicious for adenocarcinoma.
However, FNA of prostate for cytology is uncommon today due to use of biopty gun and core of tissue for better diagnosis.
References:
1 The Manual of Cytotechnology, Catherine M. Keebler2 The art & Science of Cytopathology, Richard M Demay3 Manual and Atlas of Fine Needle Aspiration Cytology, Svante R. Orell
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Normal prostatic ductal cells
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Adenocarcinoma of Prostate
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