Guide to diagnosing primary pancreatic lymphoma, B-cell type: Immunocytochemistry improves the diagnostic accuracy of endoscopic ultrasonography-guided fine needle aspiration cytology
Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, Japan. Diagnostic Cytopathology
(Impact Factor: 1.12).
08/2012; 40(8):732-6. DOI: 10.1002/dc.21662
Primary pancreatic lymphoma (PPL) is a rare disease with <1%of extranodal non-Hodgkin's lymphoma arising in the pancreas. This report provides immunocytochemical information on PPL that would be valuable for making differential diagnoses between PPL, pancreatic neuroendocine tumor, acinar cell carcinoma, and pancreatic ductal cancer. A 68-year-old woman had a chief complaint of abdominal pain. Fine needle aspiration cytology (FNAC)was performed. The FNAC smear showed moderate cellularity,with a small to moderate number of irregular cells and lymphocytes.No epithelial tumor clusters or abundant mucoid background were seen. The cells were scattered with pleomorphism and showed irregular nuclear shapes with finely granular chromatin,an increased nuclei–cytoplasm ratio, and prominent nucleoli.Cytologically, PPL was suspected with Papanicolaou staining but definite diagnosis was not made. Therefore, the specimen was destained, immunocytochemically examined for leukocyte common antigen (LCA), and PPL was suspected again. Numerous tumor cells were found in the surgical sample and tumor cells were positive for CD20 and negative for CD45RO. Based on these findings,the tumor was diagnosed as PPL, B-cell type. The preoperative FNAC smear that was examined for LCA was then reexamined for CD20, CEA, and Synaptophysin. As a result, the tumor cells were positive for LCA and CD20, whereas they were negative for CEA and Synaptophysin. Taking these findings together with the cytopathologic findings, this specimen was reconfirmed as PPL. Immunocytochemical examination for LCA and CD20 is useful in the identification of malignant pancreatic lymphoma, B-cell type.
Figures in this publication
Available from: Amir Houshang Mohammad Alizadeh
- "EUS-guided fine needle biopsy of tumors can also be performed and provide a histological diagnosis of PPL in some cases . EUS-guided FNA (EUS-FNA) of pancreatic masses is as accurate as CT/ultrasound-guided sampling and surgical biopsies , and immunocytochemistry examination of the specimen can improve the accuracy of EUS-FNA cytology . "
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ABSTRACT: We report a rare case of pancreas tumor (lymphoma) in a patient with a history of chronic hepatitis C virus (HCV) infection without treatment, with a high viral load (20,199,805 IU/ml). He presented with abdominal pain, jaundice, weight loss and sweating. Computed tomography showed a hypodense mass located in the head of the pancreas, and immunohistochemistry of a specimen obtained by endoscopic ultrasound-guided fine needle aspiration revealed non-Hodgkin's lymphoma of the pancreas, B cell type. An association of HCV infection with pancreatic lymphoma has only been reported rarely in the literature and its clinical significance is uncertain.
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ABSTRACT: Once focused mainly on the characterization of neoplasms, immunohistochemistry (IHC) today is used in the investigation of a broad range of disease processes with applications in diagnosis, prognostication, therapeutic decisions to tailor treatment to an individual patient, and investigations into the pathogenesis of disease. This review addresses the technical aspects of immunohistochemistry (and, to a lesser extent, immunocytochemistry) with attention to the antigen-antibody reaction, optimal fixation techniques, tissue processing considerations, antigen retrieval methods, detection systems, selection and use of an autostainer, standardization and validation of IHC tests, preparation of proper tissue and reagent controls, tissue microarrays and other high-throughput systems, quality assurance/quality control measures, interpretation of the IHC reaction, and reporting of results. It is now more important than ever, with these sophisticated applications, to standardize the entire IHC process from tissue collection through interpretation and reporting to minimize variability among laboratories and to facilitate quantification and interlaboratory comparison of IHC results.
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