Marilin Rosa, MD
Lee Moffitt Cancer Center and Research Institute
Tampa, Florida

Disclosure: I do not have any affiliations or financial interests in any of the corporate organizations involved with the products to which my case study will refer.

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Clinical History

The patient is a 71-year-old male with a significant medical history of “skin cancer” removed from his face one year prior. On surveillance imaging (PET scan), a new uptake of unknown

significance was visualized in the pancreatic body. The patient denied any history of pancreatitis or family history of pancreatic cancer. He denied abdominal pain, weight loss, nausea, vomiting, or diarrhea. The patient was referred for endoscopic ultrasound to evaluate the lesion and to obtain tissue for a diagnosis. Endoscopic ultrasound-guided fine needle (EUS-FNAB) aspiration was performed.

Cytopathology Features:

The smears and cell block are highly cellular and show a poorly cohesive population of small-to-intermediate-sized cells with high nuclear/cytoplasmic ratio and very scant to imperceptible cytoplasm. The nuclei display stippled nuclear chromatin, mild to moderate anisokaryosis, and inconspicuous nucleoli. The cells show occasional molding in a background of apoptotic cells. Cytologic features are consistent with neuroendocrine carcinoma. Immunostains were performed. The tumor cells were positive for neuroendocrine marker INSM1 and CK-20 (paranuclear dot-like pattern) and negative for LCA and chromogranin.

Figure 1: Fine needle aspiration smear of the pancreatic mass reveals a highly cellular smear composed of small blue cells (DQ, x100) – (starting from the left)

Figure 2: A closer view reveals the aspiration to be composed of monotonous round cells with scant cytoplasm and with occasional molding. Apoptotic bodies are seen in the background (DQ, x200)

Figure 3: Papanicolaou stain shows cells with imperceptible cytoplasm, mild crushing artifact and small nucleoli (PAP, x200)

Figure 4: Cell block shows a monotonous small blue cell population (H&E, x100)