Cytology of Normal Pancreas

  • Ami P. Patel
  • Rema RaoEmail author
Part of the Essentials in Cytopathology book series (EICP, volume 28)


Pancreatic neoplasms represent a diagnostic dilemma for clinicians, surgeons, and pathologists alike. With the increasing use of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), pancreatic cytopathology is at the forefront in the diagnosis and management of patients with a pancreatic mass. In addition, as the fourth leading cause of cancer-related deaths, pancreatic adenocarcinoma continues to be a significant burden on health care with increasing overall mortality despite advancing surgical and chemotherapeutic efforts. Therefore, early definitive diagnosis is an integral step in the management of these patients. One cannot delve into the complexities of the neoplastic pancreas without a complete and vital discussion on benign pancreatic cytology. An awareness of the approach for pancreatic fine-needle aspiration and regional anatomy is also important to avoid common (and potentially catastrophic) pitfalls and to ensure an accurate and timely diagnosis.


Pancreas Fine-needle aspiration Endoscopic ultrasound Benign pancreatic cytology 


  1. 1.
    Collins JA, Ali SZ, VandenBussche CJ. Pancreatic cytopathology. Surg Pathol Clin. 2016;9(4):661–76.CrossRefGoogle Scholar
  2. 2.
    Edge SB, Compton CC. The American joint committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.CrossRefGoogle Scholar
  3. 3.
    Coley SC, Strickland NH, Walker JD, Williamson RC. Spiral CT and the pre-operative assessment of pancreatic adenocarcinoma. Clin Radiol. 1997;52(1):24–30.CrossRefGoogle Scholar
  4. 4.
    Centeno BA. Pancreatic cytopathology: practical points to avoid common pitfalls. United States and Canadian Academy of Pathology. 2011.Google Scholar
  5. 5.
    Kurzawinski TR, Deery A, Dooley JS, Dick R, Hobbs KE, Davidson BR. A prospective study of biliary cytology in 100 patients with bile duct strictures. Hepatology. 1993;18(6):1399–403.CrossRefGoogle Scholar
  6. 6.
    Fogel EL, Sherman S. How to improve the accuracy of diagnosis of malignant biliary strictures. Endoscopy. 1999;31(9):758–60.CrossRefGoogle Scholar
  7. 7.
    Hoda RS, Pitman MB. Pancreatic cytology. Surg Pathol Clin. 2018;11(3):563–88.CrossRefGoogle Scholar
  8. 8.
    Avadhani V, Hacihasanoglu E, Memis B, Pehlivanoglu B, Hanley KZ, Krishnamurti U, et al. Cytologic predictors of malignancy in bile duct brushings: a multi-reviewer analysis of 60 cases. Mod Pathol. 2017;30(9):1273–86.CrossRefGoogle Scholar
  9. 9.
    Conrad R, Castelino-Prabhu S, Cobb C, Raza A. Cytopathology of the pancreatobiliary tract-the agony, and sometimes, the ease of it. J Gastrointest Oncol. 2013;4(2):210–9.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Bellizzi AM, Stelow EB. Pancreatic cytopathology: a practical approach and review. Arch Pathol Lab Med. 2009;133(3):388–404.PubMedGoogle Scholar
  11. 11.
    Puli SR, Bechtold ML, Buxbaum JL, Eloubeidi MA. How good is endoscopic ultrasound-guided fine-needle aspiration in diagnosing the correct etiology for a solid pancreatic mass?: a meta-analysis and systematic review. Pancreas. 2013;42(1):20–6.CrossRefGoogle Scholar
  12. 12.
    Chen J, Yang R, Lu Y, Xia Y, Zhou H. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesion: a systematic review. J Cancer Res Clin Oncol. 2012;138(9):1433–41.CrossRefGoogle Scholar
  13. 13.
    Horwhat JD, Paulson EK, McGrath K, Branch MS, Baillie J, Tyler D, et al. A randomized comparison of EUS-guided FNA versus CT or US-guided FNA for the evaluation of pancreatic mass lesions. Gastrointest Endosc. 2006;63(7):966–75.CrossRefGoogle Scholar
  14. 14.
    Affolter KE, Schmidt RL, Matynia AP, Adler DG, Factor RE. Needle size has only a limited effect on outcomes in EUS-guided fine needle aspiration: a systematic review and meta-analysis. Dig Dis Sci. 2013;58(4):1026–34.CrossRefGoogle Scholar
  15. 15.
    Volmar KE, Vollmer RT, Jowell PS, Nelson RC, Xie HB. Pancreatic FNA in 1000 cases: a comparison of imaging modalities. Gastrointest Endosc. 2005;61(7):854–61.CrossRefGoogle Scholar
  16. 16.
    Micames C, Jowell PS, White R, Paulson E, Nelson R, Morse M, et al. Lower frequency of peritoneal carcinomatosis in patients with pancreatic cancer diagnosed by EUS-guided FNA vs. percutaneous FNA. Gastrointest Endosc. 2003;58(5):690–5.CrossRefGoogle Scholar
  17. 17.
    Chong A, Venugopal K, Segarajasingam D, Lisewski D. Tumor seeding after EUS-guided FNA of pancreatic tail neoplasia. Gastrointest Endosc. 2011;74(4):933–5.CrossRefGoogle Scholar
  18. 18.
    Krasinskas AM. Developmental disorders of the gallbladder, extrahepatic biliary tract, and pancreas. In: Odze RD, Goldblum JR, editors. Surgical pathology of the GI tract, liver, biliary tract and pancreas: Saunders; 2015. p. 980–94.Google Scholar
  19. 19.
    Kozu T, Suda K, Toki F. Pancreatic development and anatomical variation. Gastrointest Endosc Clin N Am. 1995;5(1):1–30.CrossRefGoogle Scholar
  20. 20.
    Pitman MB. Pancreas and biliary tree. In: Cytology: diagnostic principles and clinical correlates: Saunders; 2014. p. 399–421.Google Scholar
  21. 21.
    Zaman MB. The pancreas. In: Koss LG, editor. Diagnostic cytology and its histopathologic bases, 2. 5th ed: Lippincott Williams & Wilkins; 2006. p. 1428–56.Google Scholar
  22. 22.
    Stelow EB, Bardales RH, Shami VM, Woon C, Presley A, Mallery S, et al. Cytology of pancreatic acinar cell carcinoma. Diagn Cytopathol. 2006;34(5):367–72.CrossRefGoogle Scholar
  23. 23.
    Centeno B. Diagnostic cytology of the biliary tract and Pancreas. In: Odze RD, Goldblum JR, editors. Surgical pathology of the GI tract, liver, biliary tract and pancreas. 4th ed: Saunders; 2015. p. 950–79.Google Scholar
  24. 24.
    Collins BT, Cramer HM. Fine-needle aspiration cytology of islet cell tumors. Diagn Cytopathol. 1996;15(1):37–45.CrossRefGoogle Scholar
  25. 25.
    Nguyen GK, Rayani NA. Hyperplastic and neoplastic endocrine cells of the pancreas in aspiration biopsy. Diagn Cytopathol. 1986;2(3):204–11.CrossRefGoogle Scholar
  26. 26.
    Layfield LJ, Jarboe EA. Cytopathology of the pancreas: neoplastic and nonneoplastic entities. Ann Diagn Pathol. 2010;14(2):140–51.CrossRefGoogle Scholar
  27. 27.
    Stelow EB, Bardales RH, Stanley MW. Pitfalls in endoscopic ultrasound-guided fine-needle aspiration and how to avoid them. Adv Anat Pathol. 2005;12(2):62–73.CrossRefGoogle Scholar
  28. 28.
    Nagle JA, Wilbur DC, Pitman MB. Cytomorphology of gastric and duodenal epithelium and reactivity to B72.3: a baseline for comparison to pancreatic lesions aspirated by EUS-FNAB. Diagn Cytopathol. 2005;33(6):381–6.CrossRefGoogle Scholar
  29. 29.
    Stelow EB, Stanley MW, Bardales RH, Mallery S, Lai R, Linzie BM, et al. Intraductal papillary-mucinous neoplasm of the pancreas. The findings and limitations of cytologic samples obtained by endoscopic ultrasound-guided fine-needle aspiration. Am J Clin Pathol. 2003;120(3):398–404.CrossRefGoogle Scholar
  30. 30.
    Emerson RE, Randolph ML, Cramer HM. Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of intraductal papillary mucinous neoplasm of the pancreas is highly predictive of pancreatic neoplasia. Diagn Cytopathol. 2006;34(7):457–62.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineWeill-Cornell Medicine, New York Presbyterian HospitalNew YorkUSA

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