Case Report
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 14, 2007; 13(38): 5158-5163
Published online Oct 14, 2007. doi: 10.3748/wjg.v13.i38.5158
Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of solid pseudopapillary tumor of the pancreas: A case report and literature review
Charitini Salla, Paschalis Chatzipantelis, Panagiotis Konstantinou, Ioannis Karoumpalis, Akrivi Pantazopoulou, Victoria Dappola
Charitini Salla, Panagiotis Konstantinou, Akrivi Pantazopoulou, Victoria Dappola, Department of Cytology, Athens General Hospital, Athens 11635, Greece
Paschalis Chatzipantelis, Department of Pathology, Areteion University Hospital, Athens 11635, Greece
Ioannis Karoumpalis, Department of Gastroenterology, Athens General Hospital, Athens 11635, Greece
Author contributions: All authors contributed equally to the work.
Correspondence to: Paschalis Chatzipantelis, Department of Pathology, Areteion University Hospital, 6-8 Stasinou Street, Athens 11635, Greece. pchatzipantelis@yahoo.com
Telephone: +30-210-7259424 Fax: +30-210-9480375
Received: June 4, 2007
Revised: July 28, 2007
Accepted: August 6, 2007
Published online: October 14, 2007
Abstract

We describe the clinical, imaging and cytopathological features of solid pseudopapillary tumor of the pancreas (SPTP) diagnosed by endoscopic ultrasound-guided (EUS-guided) fine-needle aspiration (FNA). A 17-year-old woman was admitted to our hospital with complaints of an unexplained episodic abdominal pain for 2 mo and a short history of hypertension in the endocrinology clinic. Clinical laboratory examinations revealed polycystic ovary syndrome, splenomegaly and low serum amylase and carcinoembryonic antigen (CEA) levels. Computed tomography (CT) analysis revealed a mass of the pancreatic tail with solid and cystic consistency. EUS confirmed the mass, both in body and tail of the pancreas, with distinct borders, which caused dilation of the peripheral part of the pancreatic duct (major diameter 3.7 mm). The patient underwent EUS-FNA. EUS-FNA cytology specimens consisted of single cells and aggregates of uniform malignant cells, forming microadenoid structures, branching, papillary clusters with delicate fibrovascular cores and nuclear overlapping. Naked capillaries were also seen. The nuclei of malignant cells were round or oval, eccentric with fine granular chromatin, small nucleoli and nuclear grooves in some of them. The malignant cells were periodic acid Schiff (PAS)-Alcian blue (+) and immunocytochemically they were vimentin (+), CA 19.9 (+), synaptophysin (+), chromogranin (-), neuro-specific enolase (-), a1-antitrypsin and a1-antichymotrypsin focal positive. Cytologic findings were strongly suggestive of SPTP. Biopsy confirmed the above cytologic diagnosis. EUS-guided FNA diagnosis of SPTP is accurate. EUS findings, cytomorphologic features and immunostains of cell block help distinguish SPTP from pancreatic endocrine tumors, acinar cell carcinoma and papillary mucinous carcinoma.

Keywords: Endosonography; Fine-needle aspiration; Solid pseudopapillary tumor; Pancreas; Cytology