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Role of endoscopic ultrasound-guided fine needle aspiration biopsies in diagnosing pancreatic neoplasms in the paediatric population: experience from a tertiary center and review of the literature Cover

Role of endoscopic ultrasound-guided fine needle aspiration biopsies in diagnosing pancreatic neoplasms in the paediatric population: experience from a tertiary center and review of the literature

Open Access
|Feb 2024

Figures & Tables

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.
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).
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).
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).

Results of the immunochemical reactions in both cases, on cytological and histological samples

Caseβ-CateninCyclin D1Synapto physinChromo graninCD56PRCD10CKAE1/AE3SOX11
1 cyto++−++/++
1 histo+///////+
2 cyto+++−−++−++
2 histo++Focally +/////+

Pancreatic neoplasms diagnosed by FNAB in the pediatric population: cases in the literature

StudyNo of cases/No with tumourSex/age (y)EUS-FNAB non tumour diagnosisEUS-FNAB tumour diagnosisEUS-FNAB complicationsTumour histologyFollow-up
Nabi Z et al.834/23NA/Median age 15 (8–18)Inflammatory mass, Pseudocyst, Lymphoepithelial cyst, Epithelial cystSPN (21), Pancreatoblastoma (1), Round cell tumor (1)Throat pain (7), abdominal pain (2), self-limiting bleeding (2), fever (1)88% confirmed EUS-FNA diagnosisNA
Al Rashdan A et al.99/3NA/Median age 16 (4–18)Cysts, InflammationSPN (2), Carcinoid tumour (1)NoneSPNUneventful (SPN), Died of metastatic disease (Carcinoid tumour)
Gordon K et al.106/3NA/Average weight 70 kgPseudocyst (4), multiple unilocular cysts (1)SPN (2), InsulinomaMild pancreatitis (1)NAMultiple endocrine neoplasia 1 (Insulinoma)
Jia Y et al.111/0F/13Simple pancreatic cystNoneNoneNoneNone
Mahida JB et al.121/1F/13NoneSPN (1)NoneSPNNo recurrence
Attila T et al.136/2(3)*4M,2F/10-16Focal pancreatitis, Chronic pancreatitisB-cell lymphoma, Islet cell tumour, Suspicious of malignancyNoneB-cell lymphoma, Islet cell tumour, Sclerosing pancreatitisMultiple endocrine neoplasia 1 (1), NA
Bardales RH et al.142/2F/13, 18NoneSPN (2)NASPNNone
Nadler EP et al.151/1F/13NoneSPN (1)NoneSPNNo recurrence.
DOI: https://doi.org/10.2478/raon-2024-0008 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 78 - 86
Submitted on: Jul 14, 2023
Accepted on: Oct 7, 2023
Published on: Feb 21, 2024
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 times per year

© 2024 Maja Kebe Radulovic, Jernej Brecelj, Andrej Gruden, Margareta Strojan Flezar, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.