Endoscopic ultrasound guided fine needle aspiration biopsy of autoimmune pancreatitis: diagnostic criteria and pitfalls

Vikram Deshpande, Deshpande V, Mino-Kenudson M, Mari Mino-Kenudson, William R Brugge, Brugge WR, Pitman MB, Martha B. Pitman, Carlos Fernandez-del Castillo, Fernandez-del Castillo C, Andrew L Warshaw, Warshaw AL, Lauwers GY, Gregory Y. Lauwers
The American journal of surgical pathology · 2005 · vol. 29(11) , pp. 1464–71 · doi:10.1097/01.pas.0000173656.49557.48 · PMID:16224213
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This study analyzes endoscopic ultrasound-guided fine needle aspiration biopsy features in autoimmune pancreatitis, identifying high cellularity stromal fragments with lymphoid infiltrates as key diagnostic criteria that help distinguish the condition from pancreatic malignancies.

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This study analyzed the cytomorphologic features of autoimmune pancreatitis using endoscopic ultrasound-guided fine needle aspiration biopsy in sixteen patients. The researchers compared these findings against cohorts with pancreatic ductal adenocarcinoma and chronic pancreatitis, identifying high cellularity stromal fragments with lymphoid infiltrates as a distinguishing characteristic. While three false-positive diagnoses occurred, the presence of these specific histological patterns alongside clinical data could help exclude malignancy and prevent unnecessary surgical resection. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Autoimmune pancreatitis (AIP) is a benign inflammatory disease of the pancreas that mimics pancreatic malignancy both clinically and radiologically. The fine needle aspiration biopsy (FNAB) features of AIP have not previously been documented. We report our experience with AIP, highlight pitfalls, and perform a comprehensive analysis of the cytomorphologic features of this condition. We identified 16 patients with AIP, initially evaluated by endoscopic ultrasound (EUS)-guided FNAB, 11 of whom subsequently underwent a pancreatoduodenectomy. We compared these to a cohort of EUS-guided aspirates from ductal carcinoma of the pancreas (n = 16) and chronic pancreatitis, not otherwise specified (NOS) (n = 19). On all 51 cases, we semiquantitatively evaluated presence and atypia of ductal cells, presence and cellularity of stromal fragments, and inflammatory cells, type and distribution. Fifty percent (8 of 16) of the AIP cases presented as obstructive jaundice. EUS and CT scan showed mass lesions in 10 and 6 cases, respectively. There were three false-positive cytologic diagnoses, an adenocarcinoma, a solid-pseudopapillary tumor and a mucinous neoplasm. Ductal epithelium was inconspicuous and was seen in 6 cases. The FNAB samples showed background lymphocytes in three AIP cases, a feature absent in the control cohort. Stromal fragments with embedded lymphocytes (greater than 30 per 60x) were seen in 37.5% of AIP cases and only rarely with adenocarcinoma (12.5%) and pancreatitis, NOS (0%). The cellularity of stromal fragments was significantly higher in AIP than in the control group. The presence of stromal fragments of high cellularity with a lymphoid infiltrate in conjunction with clinical and radiology findings could potentially both establish a diagnosis of AIP and exclude carcinoma, thus preventing pancreatic resection.
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Endoscopic Ultrasound Guided Fine Needle Aspiration Biopsy of Autoimmune Pancreatitis Diagnostic Criteria and Pitfalls - Vikram Deshpande - Mari Mino-Kenudson - William R Brugge - Martha B Pitman - Carlos Fernandez-del Castillo - Andrew L Warshaw - Gregory Y Lauwers Abstract: Autoimmune pancreatitis (AIP) is a benign inflammatory disease of the pancreas that mimics pancreatic malignancy both clinically and radiologically. The fine needle aspiration biopsy (FNAB) features of AIP have not previously been documented. We report our experience with AIP, highlight pitfalls, and perform a comprehensive analysis of the cytomorphologic features of this condition. We identified 16 patients with AIP, initially evaluated by endoscopic ultrasound (EUS)-guided FNAB, 11 of whom subsequently underwent a pancreatoduodenectomy. We compared these to a cohort of EUS-guided aspirates from ductal carcinoma of the pancreas (n = 16) and chronic pancreatitis, not otherwise specified (NOS) (n = 19). On all 51 cases, we semiquantitatively evaluated presence and atypia of ductal cells, presence and cellularity of stromal fragments, and inflammatory cells, type and distribution. Fifty percent (8 of 16) of the AIP cases presented as obstructive jaundice. EUS and CT scan showed mass lesions in 10 and 6 cases, respectively. There were three false-positive cytologic diagnoses, an adenocarcinoma, a solid-pseudopapillary tumor and a mucinous neoplasm. Ductal epithelium was inconspicuous and was seen in 6 cases. The FNAB samples showed background lymphocytes in three AIP cases, a feature absent in the control cohort. Stromal fragments with embedded lymphocytes (greater than 30 per 60×) were seen in 37.5% of AIP cases and only rarely with adenocarcinoma (12.5%) and pancreatitis, NOS (0%). The cellularity of stromal fragments was significantly higher in AIP than in the control group. The presence of stromal fragments of high cellularity with a lymphoid infiltrate in conjunction with clinical and radiology findings could potentially both establish a diagnosis of AIP and exclude carcinoma, thus preventing pancreatic resection.

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MeSH descriptors

Adenocarcinoma Autoimmune Diseases Biopsy, Fine-Needle Endosonography Pancreatic Neoplasms Pancreatitis Adenocarcinoma Adolescent Adult Aged Aged, 80 and over Autoimmune Diseases Autoimmune Diseases Autoimmune Diseases Biopsy, Fine-Needle Chronic Disease Female Humans Male Middle Aged

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