Earn CME

Take the test for your Continuing Education Credit
Click Here!

Submit a Case

Click Here!

We do not have any affiliations or financial interests in any of the corporate organizations involved with the products to which our case study will refer.

Disclosure for Education Planners

Continuing Medical Education (CME): The American Society of Cytopathology is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Society of Cytopathology designates this enduring educational activity for a maximum of 1 AMA PRA Category 1 credit(s).TM Physicians should only claim credit commensurate with the extent of their participation in the activity.

American Board of Pathology Maintenance of Certification (MOC): This product can help fulfill the CME requirements and Self-Assessment Modules (SAMs) mandated by the American Board of Pathology MOC process.

Continuing Medical Laboratory Education (CMLE): The ASC designates this activity for the indicated number of CMLE credit hours and also fulfills requirements of the ABMS to participate in the Maintenance of Certification program.

This program is approved for continuing education credits in the State of Florida for 1 credit and the State of California for ½ credit.

Clinical History

This 48 year old woman has had left upper quadrant abdominal pain for about 1 year. She received an abdominal MRI as a part of her work up, which detected a 13.5 mm well circumscribed lesion in the posterior body of the pancreas. She underwent upper endoscopy with ultrasound guided fine needle aspiration of the lesion. Endosonography showed a 20 mm x 16 mm oval hypoechoic mass in the body of the pancreas. The mass had well defined borders and appeared confined to the pancreas. The pancreatic duct and remainder of the pancreatic parenchyma was essentially normal. Trans-gastric EUS FNA with core needle biopsy was performed. Diff-Quik and Papanicolaou stained smears were prepared and the needle rinses were processed for cell block preparation.

Cytopathology Features

Solid pseudopapillary neoplasm (SPN) generally produces a loosely cohesive and cellular aspirate. The tumor cells are usually small, bland, and fairly monotonous. They have a fair amount of wispy cytoplasm and the nuclei are often eccentrically located. Some cells have elongated cytoplasm. A clear cell variant of SPN has also been reported.

The nuclear contours are smooth, and some nuclear grooves may be seen. Chromatin is fine and evenly distributed throughout the nucleus with occasional inconspicuous nucleoli. Sometimes cytoplasmic hyaline globules or perinuclear vacuoles may be seen. The hyaline globules are PAS positive, diastase resistant. The cells may be arranged singly or in small clusters. Pseudopapillary structures composed of tumor cells surrounding a small capillary may also be seen. The pseudopapillary structures may have either metachromatic myxoid or hyalinized stroma and the tumor cell nuclei are often oriented away from the capillary.

The aspirate background may be hemorrhagic, with histiocytes and debris due to the rich capillary network associated with SPN, or it may be clean.

Mitotic figures should be difficult to find, if found at all. No nuclear pleomorphism should be seen.

Blythe Gorman, MD
Heidi L. Holtorf, MD, PhD

Houston Methodist Hospital
Houston, Texas

Earn CME

Take the test for your Continuing Education Credit
Click Here!

Submit a Case

Click Here!