TABLE 1.
Results of the immunochemical reactions in both cases, on cytological and histological samples
| Case | β-Catenin | Cyclin D1 | Synapto physin | Chromo granin | CD56 | PR | CD10 | CKAE1/AE3 | SOX11 |
|---|---|---|---|---|---|---|---|---|---|
| 1 cyto | + | + | −+ | − | + | / | + | − | + |
| 1 histo | + | / | / | / | / | / | / | / | + |
| 2 cyto | + | + | +− | − | −+ | − | + | −+ | + |
| 2 histo | + | + | Focally + | / | / | / | / | / | + |
[i] Cyto = cytology samples obtained by endoscopic ultrasound-guided fine needle aspiration biopsy (EUS FNAB); Histo: histology samples from the tumour resection specimen
[ii] + = positive immunostaining reaction; − = negative immunostaining reaction; / = immunostaining was not performed; +− = immunostaining reaction predominantly positive; −+ = immunostaining reaction predominanty negative
TABLE 2.
Pancreatic neoplasms diagnosed by FNAB in the pediatric population: cases in the literature
| Study | No of cases/No with tumour | Sex/age (y) | EUS-FNAB non tumour diagnosis | EUS-FNAB tumour diagnosis | EUS-FNAB complications | Tumour histology | Follow-up |
|---|---|---|---|---|---|---|---|
| Nabi Z et al.8 | 34/23 | NA/Median age 15 (8–18) | Inflammatory mass, Pseudocyst, Lymphoepithelial cyst, Epithelial cyst | SPN (21), Pancreatoblastoma (1), Round cell tumor (1) | Throat pain (7), abdominal pain (2), self-limiting bleeding (2), fever (1) | 88% confirmed EUS-FNA diagnosis | NA |
| Al Rashdan A et al.9 | 9/3 | NA/Median age 16 (4–18) | Cysts, Inflammation | SPN (2), Carcinoid tumour (1) | None | SPN | Uneventful (SPN), Died of metastatic disease (Carcinoid tumour) |
| Gordon K et al.10 | 6/3 | NA/Average weight 70 kg | Pseudocyst (4), multiple unilocular cysts (1) | SPN (2), Insulinoma | Mild pancreatitis (1) | NA | Multiple endocrine neoplasia 1 (Insulinoma) |
| Jia Y et al.11 | 1/0 | F/13 | Simple pancreatic cyst | None | None | None | None |
| Mahida JB et al.12 | 1/1 | F/13 | None | SPN (1) | None | SPN | No recurrence |
| Attila T et al.13 | 6/2(3)* | 4M,2F/10-16 | Focal pancreatitis, Chronic pancreatitis | B-cell lymphoma, Islet cell tumour, Suspicious of malignancy | None | B-cell lymphoma, Islet cell tumour, Sclerosing pancreatitis | Multiple endocrine neoplasia 1 (1), NA |
| Bardales RH et al.14 | 2/2 | F/13, 18 | None | SPN (2) | NA | SPN | None |
| Nadler EP et al.15 | 1/1 | F/13 | None | SPN (1) | None | SPN | No recurrence. |
[i] EUS FNAB = endoscopic ultrasound-guided fine needle aspiration biopsy; F = femaleM = male; NA = not available; SPN = solid pseudopapillary neoplasm
FIGURE 1.
Case 1 during endoscopic ultrasound-guided fine needle aspiration biopsy (EUS FNAB). Linear probe echoendoscope localised in duodenum showing a round, well circumscribed, isoechogenic lesion in the pancreatic neck that was punctured transduodenaly. Tip of the needle (upper right) is in the lesion.
FIGURE 2.
Case 1 (A) Endoscopic ultrasound (EUS). A well demarcated, isoechogenic tumour with more echogenic thin border, probably representing a solid pseudopapillary neoplasm (SPN). (B) Pseudopapillary structures in a resected specimen (HE, X200). (C) Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS FNAB). Branching pseudopapillary structures with cohesive cellular clusters and a pinkish substance in the background (MGG, X100). (D) EUS FNAB. Small clusters of bland cells with a foamy macrophage and eosinophilic substance in the background (MGG, X400). (E) Cytospin showing a group of monomorphous cells with round/oval nuclei with smooth, indented nuclear membrane and grooves (arrow) (Pap, X400). (F) Positive nuclear β-Catenin reaction in the cell block (X400).
FIGURE 3.
Case 2 (A) Endoscopic ultrasound (EUS). A well demarcated, hypoechogenic tumour. (B) A slide of a resected pancreas at low magnification showing an area of normal pancreatic tissue (left) and an area of eosinophilic degenerative necrosis (right) (HE, X3). (C) Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS FNAB). Naked capillaries surrounded by necrotic cells and a group of cells with preserved nuclei (MGG X100). (D) EUS FNAB. A group of mainly necrotic cells and a few cells with preserved nuclei in between. (E) A slide of a resected pancreas at high magnification as in (B) with a positive nuclear β-Catenin reaction in the tumour (right) with a perineural invasion (arrow) (X100).