Intraductal Tubulopapillary Neoplasm of the Pancreas Masquerading as Pancreatic Neuroendocrine Carcinoma: Review of the Literature with a Case Report

Background: Intraductal tubulopapillary neoplasm of the pancreas (ITPN) is a rare tumor which was first described in 2009. We report a case with cytologic and histologic findings and discuss the pitfalls in diagnosing this entity on cytology. Case: An 82-year-old female presented with a pancreatic body mass measuring 3.3 cm. Endoscopic ultrasound-guided fine-needle aspiration showed cells in cohesive clusters with high-grade nuclear atypia. Immunohistochemistry (IHC) showed the neoplastic cells to be positive for CK19, CD56 and chromogranin (focal). Ki-67 was high at 50-60%, and chymotrypsin was negative. On the basis of this pattern of staining, the cytologic diagnosis rendered was ‘favors high-grade neuroendocrine carcinoma'. Distal pancreatic resection revealed a cystic 4-cm mass. Histologically, the tumor was seen arising from the duct with a solid growth pattern, tubule formation and papillary structures. IHC showed the tumor to be negative for chromogranin, synaptophysin, CD56, trypsin and chymotrypsin. The Ki-67 index was 70%. The final diagnosis was noninvasive ITPN. Conclusion: We review the literature and discuss the cytomorphologic features and IHC patterns characteristic of this new entity on cytology material in addition to the pitfalls of the cytologic diagnosis.

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Treatment of High-Grade Metastatic Pancreatic Neuroendocrine Carcinoma with FOLFIRINOX

Journal of Gastrointestinal Cancer ◽

10.1007/s12029-015-9689-0 ◽

2015 ◽

Vol 46 (2) ◽

pp. 166-169 ◽

Cited By ~ 5

Author(s):

Jason Zhu ◽

Jonathan R. Strosberg ◽

Evan Dropkin ◽

John H. Strickler

Keyword(s):

Neuroendocrine Carcinoma ◽

High Grade ◽

Pancreatic Neuroendocrine Carcinoma

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Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens

CytoJournal ◽

10.4103/1742-6413.90081 ◽

2011 ◽

Vol 8 ◽

pp. 20 ◽

Cited By ~ 56

Author(s):

Adrienne Carruth Griffin ◽

Lauren Ende Schwartz ◽

Zubair W. Baloch

Keyword(s):

Clinical Decision Making ◽

Malignant Tumors ◽

Diagnostic Yield ◽

Final Diagnosis ◽

Needle Aspiration ◽

Endobronchial Ultrasound ◽

Ultrasound Guided ◽

Cytologic Diagnosis ◽

Transbronchial Needle Aspiration ◽

Site Evaluation

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an integral tool in the diagnosis and staging of malignant tumors of the lung. Rapid on-site evaluation (ROSE) of fine needle aspiration (FNA) samples has been advocated for as a guide for assessing the accuracy and adequacy of biopsy samples. Although ROSE has proven useful for numerous sites and procedures, few studies have specifically investigated its utility in the assessment of EBUS-TBNA specimens. The intention of this study was to explore the utility of ROSE for EBUS-TBNA specimens. Materials and Methods: The pathology files at our institution were searched for all EBUS-TBNA cases performed between January 2010 and June 2010. The data points included number of sites sampled per patient, location of site(s) sampled, on-site evaluation performed, preliminary on-site diagnosis rendered, final cytologic diagnosis, surgical pathology follow-up, cell blocks, and ancillary studies performed. Results: A total of 294 EBUS-TBNA specimens were reviewed and included in the study; 264 of 294 (90%) were lymph nodes and 30 of 294 (10%) were lung mass lesions. ROSE was performed for 140 of 294 (48%) specimens. The on-site and final diagnoses were concordant in 104 (74%) and discordant in 36 (26%) cases. Diagnostic specimens were obtained in 132 of 140 (94%) cases with on-site evaluation and 138 of 154 (90%) without on-site evaluation. The final cytologic diagnosis was malignant in 60 of 132 (45%) cases with ROSE and 46 of 138 (33%) cases without ROSE, and the final diagnosis was benign in 57 of 132 (47%) with ROSE and 82 of 138 (59%) without ROSE. A cell block was obtained in 129 of 140 (92%) cases with ROSE and 136 of 154 (88%) cases without ROSE. Conclusions: The data demonstrate no remarkable difference in diagnostic yield, the number of sites sampled per patient, or clinical decision making between specimens collected via EBUS-TBNA with or without ROSE. As a result, this study challenges the notion that ROSE is beneficial for the evaluation of EBUS-TBNA specimens.

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Surgical resection of high‐grade nonfunctional pancreatic neuroendocrine carcinoma is associated with improved survival

Journal of Surgical Oncology ◽

10.1002/jso.26644 ◽

2021 ◽

Author(s):

Jerry Jiang ◽

Joon Park ◽

Stephanie Kim ◽

Amanda Daan ◽

Timothy Donahue ◽

...

Keyword(s):

Surgical Resection ◽

Neuroendocrine Carcinoma ◽

High Grade ◽

Pancreatic Neuroendocrine Carcinoma

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High-grade neuroendocrine carcinoma presenting as an abscess: Diagnosis by fine needle aspiration and review of the literature

Diagnostic Cytopathology ◽

10.1002/dc.20878 ◽

2008 ◽

Vol 36 (9) ◽

pp. 670-673 ◽

Cited By ~ 2

Author(s):

Jonathon B. Herbst ◽

Ann E. Walts

Keyword(s):

Neuroendocrine Carcinoma ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

High Grade ◽

Review Of The Literature ◽

Fine Needle

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Surgical Treatment as a Principle for Patients with High-Grade Pancreatic Neuroendocrine Carcinoma: A Nordic Multicenter Comparative Study

Annals of Surgical Oncology ◽

10.1245/s10434-015-5013-2 ◽

2015 ◽

Vol 23 (5) ◽

pp. 1721-1728 ◽

Cited By ~ 31

Author(s):

Sven-Petter Haugvik ◽

Eva Tiensuu Janson ◽

Pia Österlund ◽

Seppo W. Langer ◽

Ragnhild Sørum Falk ◽

...

Keyword(s):

Surgical Treatment ◽

Comparative Study ◽

Neuroendocrine Carcinoma ◽

High Grade ◽

Pancreatic Neuroendocrine Carcinoma

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A phase II trial of pembrolizumab in combination with cisplatin or carboplatin and etoposide in chemotherapy naive patients with metastatic or unresectable high-grade gastroenteropanncreatic or lung neuroendocrine carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.tps635 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. TPS635-TPS635

Author(s):

Robert A. Ramirez ◽

Marc Ryan Matrana ◽

Suma Satti ◽

Ryan Patrick Griffin ◽

Brianne A Voros ◽

...

Keyword(s):

Phase Ii ◽

Neuroendocrine Carcinoma ◽

Progression Free Survival ◽

Large Cell ◽

Protective Mechanism ◽

High Grade ◽

Open Label ◽

Histologic Diagnosis ◽

Ki 67 ◽

Recist 1.1

TPS635 Background: Combination chemotherapy (CTx) is the mainstay of treatment for patients with advanced high-grade gastroenteropancreatic neuroendocrine carcinoma (GEPNECs) and large cell neuroendocrine carcinomas (LCNECs) of the lung. Pembrolizumab (PEM) is a humanized antibody to the programmed cell death receptor (PD-1), which blocks the interaction with its cognate ligands, PD-L1 and PD-L2. PEM blocks the protective mechanism of cancer cells and allows the immune system to destroy them. Combination Ctx and immunotherapy has shown efficacy in other malignancies including small cell lung cancer. The purpose of this study is to test the efficacy, safety, and tolerability of combination CTx with PEM in patients with high-grade GEPNEC or LCNEC of the lung who are CTx naïve. Methods: This is an open label, phase II, single institution, multi-site trial using PEM in combination with either cisplatin or carboplatin and etoposide in patients with high grade GEPNECs or LCNEC of the lung who are CTx naïve. Patients with a histologic diagnosis of a GEPNECs with a Ki-67 of 55% or higher or a LCNEC of the lung will be eligible. Patients must be metastatic or unresectable; chemotherapy naïve; have at least one measurable lesion per RECIST 1.1, have an ECOG performance score of 0-1; and have a predicted life expectancy > 3 months. Approximately 36 GEPNEC and 6 LCNEC of the lung patients will be enrolled. Patients will receive PEM 200mg IV in combination with cisplatin 80 mg/m2 or carboplatin AUC 6 on day 1 and etoposide 100mg/m2 on days 1-3 of a 21-day cycle. Tumor response will be assessed by CT scan every 6 weeks using RECIST 1.1. Those patients who have responsive or stable disease after 4-6 cycles of platinum-based CTx will move to maintenance PEM every 3 weeks for up to 2 years. The primary endpoint will be progression free survival. Results: This study is open to enrollment. Clinical trial information: NCT03901378.

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