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

2. 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

11. Ductal adenocarcinoma of the pancreas
Well differentiated) )

12. 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.

13. 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 .

14. 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

15. Biopsy of the pancreas