Case 1 :Intraoperative FNA and biopsy of the pancreas Maryam Mehdizadeh MD,MIAC

A 56-year-old woman with nausea,abdominal pain and jaundice since four weeks ago and mass lesion in head of pancreas in C T scan

Ductal adenocarcinoma of the pancreas Well differentiated) )

Well differentiated ductal adenocarcinoma 1. Malignant cells are arranged in large folded sheets and three-dimensional groups or demonstrate and exag- gerated honeycomb pattern. periph- 2. Abnormal groups may be cohesive and lack eral feathering . 3.The nuclei are crowded , lose their roundness and sm- oothness and become angulated and pyramidal or carrot-shaped with focal notches and grooves . 4.Anisocytosis , nuclear enlargement , irregular chromatin clearing . 5.Mitosis and necrosis are infrequent.

Moderately and poorly differentiated adenocarcinoma 1.Malignant cells are arranged in crowded, three dimensional groups or groups with an exag- gerated honeycomb pattern. 2. Single cells with significant atypia . .The nuclei are more frequently notched or 3 deeply grooved and convoluted. 4.The nuclei are typically more hyperchromatic. 5. Mitosis are more common. 6.The smear pattern is more often necrotic .

Undifferentiated(anaplastic)adenocarcinoma Very cellular smear Bizarre spindle shaped cells associated with num- erous single sarcomatoid appearing malignant cells and multinucleated giant cells Cytophagocytosis and tumor necrosis

Biopsy of the pancreas