PT  - JOURNAL ARTICLE
AU  - Michael Steel
AU  - Samarth Rao
AU  - Julie Ho
AU  - Fergal Donnellan
AU  - Hui-Min Yang
AU  - David F Schaeffer
TI  - Cytohistological diagnosis of pancreatic serous cystadenoma: a multimodal approach
AID  - 10.1136/jclinpath-2019-205872
DP  - 2019 Sep 01
TA  - Journal of Clinical Pathology
PG  - 615--621
VI  - 72
IP  - 9
4099  - http://jcp.bmj.com/content/72/9/615.short
4100  - http://jcp.bmj.com/content/72/9/615.full
SO  - J Clin Pathol2019 Sep 01; 72
AB  - 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.