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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

Maja Kebe Radulovic
Maja Kebe Radulovic
, 
Jernej Brecelj
Jernej Brecelj
, 
Andrej Gruden
Andrej Gruden
 and 
Margareta Strojan Flezar
Margareta Strojan Flezar
   | Feb 21, 2024
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Article Category: Research Article
Published Online: Feb 21, 2024
Page range: 78 - 86
Received: Jul 14, 2023
Accepted: Oct 07, 2023
DOI: https://doi.org/10.2478/raon-2024-0008
Keywords
© 2024 Maja Kebe Radulovic et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

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

Case β-Catenin Cyclin D1 Synapto physin Chromo granin CD56 PR CD10 CKAE1/AE3 SOX11
1 cyto + + −+ − + / + − +
1 histo + / / / / / / / +
2 cyto + + +− − −+ − + −+ +
2 histo + + Focally + / / / / / +

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.
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