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What Does The Fine Needle Aspiration Test Results Indicate?

Posted on Thu, 28 May 2015

Question: FNA results: Ductal pancreatic tail adenocarcinoma. 22 gauge: 3 passes; 25 gauge 3 passes. Does single cells, monolayers, variant nucleus size & enlargement, moderately differentiated & low cellularity discount PanIn?

Answered by Dr. Shailja Puri (4 hours later)

Brief Answer:
FNA shows presence of cancer in tail of pancreas

Detailed Answer:
Hello,
Thanks for posting your query on HealthcareMagic.
The fine needle aspiration (FNA) of pancreatic mass results suggest presence of a cancer.
The cancer is present in the tail region and is arising from the duct system of the pancreas.
Other investigations CT scan also detect a mass in tail of the pancreas.
A tumor marker CA 19-9 is also elevated is a marker of pancreatic cancer.
You need to consult your referring doctor with the test report.
Further management will depend on the stage of the cancer.
If the cancer is limited to the tail only, then surgical excision of the tail will be done.
If the cancer is un-resectable, then chemotherapy or radiotherapy or both will be required.
Pancreatic cancers are quite aggressive, thus, prompt action is required.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Shailja Puri (2 hours later)

With the information I provide (the only pathology report we have) what stains, etc determine adenocarcinoma?

Answered by Dr. Shailja Puri (6 hours later)

Brief Answer:
Special stains or IHC on FNA smears is not rewarding

Detailed Answer:
Hello and welcome again,
The report that you have posted is that of FNA i.e. cytology.
The findings are quite characteristic and correlate well with elevated levels of CA-19-9 and the CT findings.
Further a biopsy will be required on which special stains can be done.
However, biopsy may not be feasible in tail of pancreases since it is a deep seated structure.
Further you need to consult your referring doctor and his team (oncosurgeon, etc) to plan treatment.
Special stains on cytology smears is not very rewarding.
Special stains or immunohistochemistry (IHC) can be done on cell block preparation.
However, this will be a decision of your treating doctor whether such investigation is required or not.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Shailja Puri (5 days later)

I am not sure if a core biopsy is needed for cell block and still don't know why 6 needle passes.

Answered by Dr. Shailja Puri (7 hours later)

Brief Answer:
Core biopsy will only be done if required, 6 needle passes to get adequate

Detailed Answer:
Hello and welcome again,
Core biopsy is not usually done in pancreatic masses however, each case is different and decision so as to hat investigation is required depends on the merit of the case.
As for 6 passes, it refers to 6 needle passes made into the pancreatic mass while performing fine needle aspiration cytology.
That investigation has already been done.
Multiple needle passes are done to get adequate cellular material from the mass lesion, thus you needn't worry about that.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Shailja Puri (17 hours later)

Thank you. Without cell block; immune staining with low cellularity what decisively determines ductual cells? I wish I had known about this site. So much is in just the pathology.

Answered by Dr. Shailja Puri (9 hours later)

Brief Answer:
Requirement of cell block and immunostaining will be decided by your doctor

Detailed Answer:
Hello and welcome again,
Whether a cell block and immunostaining is required or not will be decided by your referring doctor and pathologist.
So, I advise you to consult them regarding the requirement of the investigations.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Prasad