Detection of very well

differentiated
adenocarcinoma of
pancreas and bile duct
epithelium

TOM MENG
March 24, 2008
 Cytology of biliary tract, including the ampulla of Vater,
common bile duct, and pancreatic duct is becoming
increasingly important for variety of reasons. Cytological
examination cannot only aid in the diagnosis but can spare the
patient unnecessary surgery (2,P357).

However, adenocarcinoma of pancreas and bile duct

epithelium may be very well differentiated. Sometimes
confusion of diagnosis may occur, so distinguishing them from
benign has cytological significance.

Features will be presented to help at least diagnose

suspicious for adenocarcinoma.
 Bile duct

Normal bile ductal cells:

Cohesive, monolayer sheet of medium-sized

columnar or cuboidal cells

Form regular, honeycombing or palisading

arrangement

Nuclei are round to oval with smooth nuclear

membranes
Fine, evenly distributed chromatin
Normal bile duct cells
Normal bile duct
cells
 W.D. Adenocarcinoma of bile duct:

May be extremely well differentiated, so any

change from normal may be suspicious such as:

Loss of polarity
Overlapping
Cluster or 3-D ball
Increased N/C ratio

Slight nuclear enlargement

Slight nuclear membrane irregularities

Slight hyperchromasia
Prominent nucleoli
Adenocarcinom
a
Of bile duct
 Benign

Malignan
t
Adenocarcinoma
Of bile duct
Adenocarcinoma
Of bile duct
 Pancreas

Normal pancreatic ductal cells

The cells of the pancreatic duct and bile duct

are cytologically similar(2 P358):

Cuboidal to columnar cells, rare to see cilia

Monolayer groups usually
honeycombing or picket fencing
Round or oval basally located nuclei
Evenly distributed, finely granular chromatin

Smooth nuclear membranes

Normal
pancreati
c
Ductal
cells
 Pancreatic Adenocarcinoma

May be extremely well differentiated, so any

change from normal may be suspicious such as:

Overlapping nuclei
Clusters or 3-D ball
Loss of polarity
Increased N/C ratio
Slight nuclear enlargement
Slight hyperchromasia
Slight nuclear membrane irregularities
Prominent nucleoli
May see cytoplasmic vacuolization and mitoses
Adenocarcinoma
of pancreas
Adenocarcinoma
of pancreas
Adenocarcinoma
of pancreas
Adenocarcinoma
of pancreas
 Prostate
Adenocarcinoma of three sites may be very well
differentiated: pancreas, bile duct, and prostate. Diagnosis of
prostatic FNA is similar to pancreas and bile duct. Helpful in
prostate cytology is the presence of branching and bridging
structures = very suspicious for adenocarcinoma.

However, FNA of prostate for cytology is uncommon today

due to use of biopty gun and core of tissue for better diagnosis.

References:
1 The Manual of Cytotechnology, Catherine M. Keebler
2 The art & Science of Cytopathology, Richard M Demay
3 Manual and Atlas of Fine Needle Aspiration Cytology, Svante R.
Orell
Normal
prostatic
ductal cells
Adenocarcinoma of
Prostate