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Cytohistological diagnosis of pancreatic serous cystadenoma: a multimodal approach
  1. Michael Steel1,
  2. Samarth Rao2,
  3. Julie Ho3,
  4. Fergal Donnellan2,
  5. Hui-Min Yang1,
  6. David F Schaeffer1
  1. 1 Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
  2. 2 Division of Gastroenterology, Vancouver General Hospital, Vancouver, British Columbia, Canada
  3. 3 Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Michael Steel, Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada; smike{at}alumni.ubc.ca

Abstract

Aims Serous cystadenomata (SCAs) are benign pancreatic cystic neoplasms that present a diagnostic challenge despite many investigational approaches. Notwithstanding the promise of molecular diagnostics, these tests have limited accessibility in day-to-day surgical pathology practices. We aim to corroborate and build on recent evidence which suggests that positive α-inhibin immunohistochemistry (IHC) is a helpful adjunct in the biopsy confirmation of pancreatic SCA.

Methods We retrospectively reviewed 22 fine-needle aspirates/biopsies from 14 patients (mean age 65 years, 47–83 years) with pancreatic multicystic lesions radiologically suspicious for SCA (location: 6 body, 2 head, 4 tail, 1 neck, 1 uncinate; cyst size: mean 3.7 cm, 2.0–7.6 cm), as well as an additional 10 pancreatic resection specimens with confirmed SCA; α-inhibin IHC was performed on all cell blocks, biopsy slides and representative resection specimen sections. Where available, associated cyst fluid was analysed for correlative vascular endothelial growth factor A (VEGF-A) and carcinoembryonic antigen levels.

Results An α-inhibin IHC sensitivity of 80% was observed in the cases with resection confirmed SCA. Of the fine-needle aspirate/biopsy specimens, 59% (13/22) contained epithelial cells strongly positive for α-inhibin. When selecting for specimens that exhibited distinct strips of epithelium, the α-inhibin strong positivity rate increased to 73% (8/11). VEGF-A values were supportive of false-negative α-inhibin IHC in three cases and true-negative α-inhibin IHC in one case.

Conclusion This study postulates a diagnostic algorithm to confirm pancreatic SCA which may help to decrease unnecessary follow-up endoscopy/surgical resection and would decrease the associated morbidity, mortality and financial costs in patients with this otherwise benign condition.

  • pancreatic serous cystadenoma
  • pancreatic cystic neoplasia
  • α-inhibin immunohistochemistry
  • fine-needle aspiration
  • intracystic cea
  • intracystic vegf
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Footnotes

  • Handling editor Runjan Chetty.

  • Contributors MS: data curation, formal analysis, writing—original draft, writing—review and editing. SR: data curation, writing—review and editing. JH: data curation, writing—review and editing. FD: supervision, data curation, writing—review and editing. H-MY: supervision, data curation, writing—review and editing. DFS: conceptualisation, data curation, supervision, methodology, writing—review and editing. FD, H-MY and DFS co-supervised this work.

  • Funding Partial funds for this project were received by the VGH and UBC Hospital Foundation.

  • Competing interests DFS reports consulting fees from Robarts Clinical Trials Inc., and the Provincial Health Services Authority, Vancouver, BC, as well as honoraria from Amgen.

  • Patient consent for publication Not required.

  • Ethics approval This manuscript has been read and approved by all authors, has not been published and is not under consideration for publication elsewhere. The study has been approved by the institutional research ethics board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

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