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Approach to Endoscopic Ultrasound-Guided FNA of the Gastrointestinal Tract and Pancreas

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Abstract

In this chapter, some of the unique aspects of EUS FNA are first introduced, such as possible confounders in the evaluation of adequacy. Thereafter, the chapter is divided into two main sections: EUS FNA of the gastrointestinal tract and pancreas.

In the gastrointestinal tract, most of the lesions are mesenchymal, and a discussion on basic imaging findings and discriminatory cytologic and IHC features is provided.

In the pancreas, the importance of the triple approach is emphasised, and a sequential approach is provided to working up pancreatic lesions. In particular, the challenging area of cystic lesions is used as an example of how a multifaceted clinical, radiologic and cytologic approach can help to tackle some of the more difficult diagnostic dilemmas.

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References

  1. Lange P, Kock K, Laustsen J, Arffmann E, Teglbjaerg PS. Endoscopic fine-needle aspiration cytology of the stomach. A new diagnostic procedure. Endoscopy. 1987;19(2):72–3.

    Article  CAS  PubMed  Google Scholar 

  2. Vilmann P, Hancke S, Henriksen FW, Jacobsen GK. Endosonographically-guided fine needle aspiration biopsy of malignant lesions in the upper gastrointestinal tract. Endoscopy. 1993;25(8):523–7.

    Article  CAS  PubMed  Google Scholar 

  3. Iglesias-Garcia J, Dominguez-Munoz JE, Abdulkader I, Larino-Noia J, Eugenyeva E, Lozano-Leon A, et al. Influence of on-site cytopathology evaluation on the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of solid pancreatic masses. Am J Gastroenterol. 2011;106(9):1705–10.

    Article  PubMed  Google Scholar 

  4. Ecka RS, Sharma M. Rapid on-site evaluation of EUS-FNA by cytopathologist: an experience of a tertiary hospital. Diagn Cytopathol. 2013;41(12):1075–80.

    Article  PubMed  Google Scholar 

  5. Jhala NC, Jhala DN, Chhieng DC, Eloubeidi MA, Eltoum IA. Endoscopic ultrasound-guided fine-needle aspiration. A cytopathologist’s perspective. Am J Clin Pathol. 2003;120(3):351–67.

    Google Scholar 

  6. Buxbaum JL, Eloubeidi MA, Lane CJ, Varadarajulu S, Linder A, Crowe AE, et al. Dynamic telecytology compares favorably to rapid onsite evaluation of endoscopic ultrasound fine needle aspirates. Dig Dis Sci. 2012;57(12):3092–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Monaco SE, Koah AE, Xing J, Ahmed I, Cuda J, Cunningham J, et al. Telecytology implementation: deployment of telecytology for rapid on-site evaluations at an Academic Medical Center. Diagn Cytopathol. 2019;47(3):206–13.

    Article  PubMed  Google Scholar 

  8. Lin O, Rudomina D, Feratovic R, Sirintrapun SJ. Rapid on-site evaluation using telecytology: a major cancer center experience. Diagn Cytopathol. 2019;47(1):15–9.

    Article  PubMed  Google Scholar 

  9. Miettinen M, Sarlomo-Rikala M, Sobin LH, Lasota J. Esophageal stromal tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas. Am J Surg Pathol. 2000;24(2):211–22.

    Article  CAS  PubMed  Google Scholar 

  10. Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006;130(10):1466–78.

    Article  CAS  PubMed  Google Scholar 

  11. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23(2):70–83.

    Article  Google Scholar 

  12. Gress FG, Savides TJ, editors. Endoscopic ultrasonography. 2nd ed. Chichester/Hoboken: Wiley-Blackwell; 2009. p. 202.

    Google Scholar 

  13. Hu J, Liu X, Ge N, Wang S, Guo J, Wang G, et al. Role of endoscopic ultrasound and endoscopic resection for the treatment of gastric schwannoma. Medicine (Baltimore). 2017;96(25):e7175.

    Article  Google Scholar 

  14. Takasumi M, Hikichi T, Takagi T, Suzuki R, Watanabe K, Nakamura J, et al. Efficacy of endoscopic ultrasound-guided fine-needle aspiration for schwannoma: six cases of a retrospective study. Fukushima J Med Sci. 2017;63(2):75–80.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Iwamuro M, Tanaka T, Kanzaki H, Kawano S, Kawahara Y, Okada H. Esophageal granular cell tumors can be differentiated from leiomyomas using endoscopic ultrasonography. Intern Med. 2018;57(11):1509–15.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sun L-J, Chen X, Dai Y-N, Xu C-F, Ji F, Chen L-H, et al. Endoscopic ultrasonography in the diagnosis and treatment strategy choice of esophageal leiomyoma. Clinics (Sao Paulo). 2017;72(4):197–201.

    Article  Google Scholar 

  17. Xu G-Q, Zhang B-L, Li Y-M, Chen L-H, Ji F, Chen W-X, et al. Diagnostic value of endoscopic ultrasonography for gastrointestinal leiomyoma. World J Gastroenterol. 2003;9(9):2088–91.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Deshpande A, Nelson DB, Corless CL, Deshpande V, O’Brien MJM. Leiomyoma of the gastrointestinal tract with interstitial cells of Cajal: a mimic of gastrointestinal stromal tumor. J Surg Pathol. 2014;38(1):72–7.

    Article  Google Scholar 

  19. Hallin M, Mudan S, Thway K. Interstitial cells of Cajal in deep esophageal leiomyoma. Int J Surg Pathol. 2017;25(1):51–3.

    Article  CAS  PubMed  Google Scholar 

  20. Heinrich MC, Corless CL, Demetri GD, Blanke CD, von Mehren M, Joensuu H, et al. Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol. 2003;21(23):4342–9.

    Article  CAS  PubMed  Google Scholar 

  21. Debiec-Rychter M, Dumez H, Judson I, Wasag B, Verweij J, Brown M, et al. Use of c-KIT/PDGFRA mutational analysis to predict the clinical response to imatinib in patients with advanced gastrointestinal stromal tumours entered on phase I and II studies of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer. 2004;40(5):689–95.

    Article  CAS  PubMed  Google Scholar 

  22. Ricci R, Chiarello G, Attili F, Fuccio L, Alfieri S, Persiani R, et al. Endoscopic ultrasound-guided fine needle tissue acquisition biopsy samples do not allow a reliable proliferation assessment of gastrointestinal stromal tumours. Dig Liver Dis. 2015;47(4):291–5.

    Article  PubMed  Google Scholar 

  23. WHO Classification of Tumours Editorial Board. Digestive System Tumours. Lyon (France): International Agency for Research on Cancer; 2019 (WHO classification of tumours series, 5th ed.; Vol.1). https://www.publications.iarc.fr/579.

  24. Nga ME, Wong ASC, Wee A, Salto-Tellez M. Cytokeratin expression in gastrointestinal stromal tumours: a word of caution. Histopathology. 2002;40(5):480–1.

    Article  CAS  PubMed  Google Scholar 

  25. Sing Y, Ramdial PK, Ramburan A, Sewram V. Cytokeratin expression in gastrointestinal stromal tumors: morphology, meaning, and mimicry. Indian J Pathol Microbiol. 2014;57(2):209–16.

    Article  PubMed  Google Scholar 

  26. Sharma S, Gupta N, Rajwanshi A, Saikia UN. Inflammatory myofibroblastic tumour: a diagnostic challenge on fine needle aspiration cytology. Cytopathology. 2016;27(6):512–6.

    Article  CAS  PubMed  Google Scholar 

  27. Stoll LM, Li QK. Cytology of fine-needle aspiration of inflammatory myofibroblastic tumor. Diagn Cytopathol. 2011;39(9):663–72.

    Article  PubMed  Google Scholar 

  28. Raddaoui E, Al-Sharabi A, Almadi MA. Cytology findings in pancreatic heterotopia, a potential pitfall for malignancy: a case report and literature review. Saudi J Gastroenterol. 2015;21(2):116–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Stoos-Veic T, Tadic M, Aralica G. EUS-FNA of Brunner’s gland hamartoma: a case report. Cytopathology. 2013;24(3):194–6.

    Article  CAS  PubMed  Google Scholar 

  30. Pitman MB, Layfield LJ. Guidelines for pancreaticobiliary cytology from the Papanicolaou Society of Cytopathology: a review. Cancer Cytopathol. 2014;122(6):399–411.

    Article  PubMed  Google Scholar 

  31. Pitman MB, Layfield LJ. The papanicolaou society of cytopathology system for reporting pancreaticobiliary cytology [internet]. Cham: Springer International Publishing; 2015. http://link.springer.com/10.1007/978-3-319-16589-9. [cited 2019 Jul 25].

    Book  Google Scholar 

  32. Odze RD, Goldblum JR. Surgical pathology of the GI tract, liver, biliary tract, and pancreas [Internet]. 2015. https://www.clinicalkey.com/dura/browse/bookChapter/3-s2.0-C20110697145. [cited 2019 Jul 25].

  33. Chai SM, Herba K, Kumarasinghe MP, de Boer WB, Amanuel B, Grieu-Iacopetta F, et al. Optimizing the multimodal approach to pancreatic cyst fluid diagnosis: developing a volume-based triage protocol. Cancer Cytopathol. 2013;121(2):86–100.

    Article  CAS  PubMed  Google Scholar 

  34. Solomon S, Das S, Brand R, Whitcomb DC. Inherited pancreatic cancer syndromes. Cancer J. 2012;18(6):485–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Pavai S, Yap SF. The clinical significance of elevated levels of serum CA 19-9. Med J Malaysia. 2003;58(5):667–72.

    CAS  PubMed  Google Scholar 

  36. Lee LS. Diagnosis of pancreatic neuroendocrine tumors and the role of endoscopic ultrasound. Gastroenterol Hepatol. 2010;6(8):520–2.

    Google Scholar 

  37. Béchade D, Desjardin M, Salmon E, Désolneux G, Bécouarn Y, Evrard S, et al. Pancreatic acinar cell carcinoma. Case Rep Gastroenterol. 2016;10(1):179–85.

    Article  Google Scholar 

  38. Yoneda M, Kanayama K, Imai H, Shiraishi T. Report of a case of acinar cell carcinoma with its differential diagnosis on endoscopic ultrasound-guided fine-needle aspiration cytology. J Cytol. 2014;31(2):93–5.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Merkle EM, Bender GN, Brambs HJ. Imaging findings in pancreatic lymphoma: differential aspects. AJR Am J Roentgenol. 2000;174(3):671–5.

    Article  CAS  PubMed  Google Scholar 

  40. Lee LK, Sahani DV. Autoimmune pancreatitis in the context of IgG4-related disease: review of imaging findings. World J Gastroenterol. 2014;20(41):15177–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Busireddy KK, AlObaidy M, Ramalho M, Kalubowila J, Baodong L, Santagostino I, et al. Pancreatitis-imaging approach. World J Gastrointest Pathophysiol. 2014;5(3):252–70.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Bick BL, Enders FT, Levy MJ, Zhang L, Henry MR, Abu Dayyeh BK, et al. The string sign for diagnosis of mucinous pancreatic cysts. Endoscopy. 2015;47(7):626–31.

    Article  PubMed  Google Scholar 

  43. Oh SH, Lee JK, Lee KT, Lee KH, Woo YS, Noh DH. The combination of cyst fluid Carcinoembryonic antigen, cytology and viscosity increases the diagnostic accuracy of mucinous pancreatic cysts. Gut Liver. 2017;11(2):283–9.

    Article  CAS  PubMed  Google Scholar 

  44. Robins DB, Katz RL, Evans DB, Atkinson EN, Green L. Fine needle aspiration of the pancreas. In quest of accuracy. Acta Cytol. 1995;39(1):1–10.

    CAS  PubMed  Google Scholar 

  45. Xiao G-Q. Fine-needle aspiration of cystic pancreatic mucinous tumor: oncotic cell as an aiding diagnostic feature in paucicellular specimens. Diagn Cytopathol. 2009;37(2):111–6.

    Article  PubMed  Google Scholar 

  46. Cui Y, Khanna LG, Saqi A, Crapanzano JP, Mitchell JM, Sethi A, et al. The Role of Endoscopic Ultrasound-Guided Ki67 in the Management of Non-Functioning Pancreatic Neuroendocrine Tumors. Clin Endosc. 2020;53(2):213–20.

    Google Scholar 

  47. Di Leo M, Poliani L, Rahal D, Auriemma F, Anderloni A, Ridolfi C, et al. Pancreatic neuroendocrine tumours: the role of endoscopic ultrasound biopsy in diagnosis and grading based on the WHO 2017 classification. Dig Dis. 2019;37(4):325–33.

    Article  PubMed  Google Scholar 

  48. Laskiewicz L, Jamshed S, Gong Y, Ainechi S, LaFemina J, Wang X. The diagnostic value of FNA biopsy in grading pancreatic neuroendocrine tumors: FNA biopsy and grading in PNETs. Cancer Cytopathol. 2018;126(3):170–8.

    Article  CAS  PubMed  Google Scholar 

  49. La Rosa S, Adsay V, Albarello L, Asioli S, Casnedi S, Franzi F, et al. Clinicopathologic study of 62 acinar cell carcinomas of the pancreas: insights into the morphology and immunophenotype and search for prognostic markers. Am J Surg Pathol. 2012;36(12):1782–95.

    Article  PubMed  Google Scholar 

  50. Schechter S, Shi J. Simple mucinous cyst of the pancreas: review and update. Arch Pathol Lab Med. 2017;141(10):1330–5.

    Article  PubMed  Google Scholar 

  51. Recine M, Kaw M, Evans DB, Krishnamurthy S. Fine-needle aspiration cytology of mucinous tumors of the pancreas. Cancer. 2004;102(2):92–9.

    Article  PubMed  Google Scholar 

  52. Kaiserling E, Seitz KH, Rettenmaier G, Seidel W, Kahlfuss R, Walz-Mattmüller R, et al. Lymphoepithelial cyst of the pancreas. Clinical, morphological, and immunohistochemical findings. Zentralbl Pathol. 1991;137(5):431–8.

    CAS  PubMed  Google Scholar 

  53. Policarpio-Nicolas ML, Shami VM, Kahaleh M, Adams RB, Mallery S, Stanley MW, et al. Fine-needle aspiration cytology of pancreatic lymphoepithelial cysts. Cancer. 2006;108(6):501–6.

    Article  PubMed  Google Scholar 

  54. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, Centeno BA, Szydlo T, Regan S, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126(5):1330–6.

    Article  PubMed  Google Scholar 

  55. Kadayifci A, Al-Haddad M, Atar M, Dewitt JM, Forcione DG, Sherman S, et al. The value of KRAS mutation testing with CEA for the diagnosis of pancreatic mucinous cysts. Endosc Int Open. 2016;4(4):E391–6.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Lee J-H, Kim Y, Choi J-W, Kim Y-S. KRAS, GNAS, and RNF43 mutations in intraductal papillary mucinous neoplasm of the pancreas: a meta-analysis. SpringerPlus [Internet]. 2016;5(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960083/. [cited 2019 Aug 1].

  57. Khalid A, Zahid M, Finkelstein SD, LeBlanc JK, Kaushik N, Ahmad N, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc. 2009;69(6):1095–102.

    Article  PubMed  Google Scholar 

  58. Kadayifci A, Atar M, Wang JL, Forcione DG, Casey BW, Pitman MB, et al. Value of adding GNAS testing to pancreatic cyst fluid KRAS and carcinoembryonic antigen analysis for the diagnosis of intraductal papillary mucinous neoplasms. Dig Endosc. 2017;29(1):111–7.

    Article  PubMed  Google Scholar 

  59. Singhi AD, Nikiforova MN, Fasanella KE, McGrath KM, Pai RK, Ohori NP, et al. Preoperative GNAS and KRAS testing in the diagnosis of pancreatic mucinous cysts. Clin Cancer Res. 2014;20(16):4381–9.

    Article  CAS  PubMed  Google Scholar 

  60. van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc. 2005;62(3):383–9.

    Article  PubMed  Google Scholar 

  61. Salomao M, Remotti H, Allendorf JD, Poneros JM, Sethi A, Gonda TA, et al. Fine-needle aspirations of pancreatic serous cystadenomas: improving diagnostic yield with cell blocks and α-inhibin immunohistochemistry. Cancer Cytopathol. 2014;122(1):33–9.

    Article  PubMed  Google Scholar 

  62. Carr RA, Yip-Schneider MT, Dolejs S, Hancock BA, Wu H, Radovich M, et al. Pancreatic Cyst Fluid Vascular Endothelial Growth Factor A and Carcinoembryonic Antigen: A Highly Accurate Test for the Diagnosis of Serous Cystic Neoplasm. J Am Coll Surg. 2017 May 18.

    Google Scholar 

  63. Charville GW, Kao C-S. Serous neoplasms of the pancreas: a comprehensive review. Arch Pathol Lab Med. 2018;142(9):1134–40.

    Article  PubMed  Google Scholar 

  64. Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang J-Y, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.

    Article  Google Scholar 

  65. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018;67(5):789–804.

    Article  Google Scholar 

  66. Tanaka M, Fernández-del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T, et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17(5):738–53.

    Article  PubMed  Google Scholar 

  67. Siddiqui AA, Kowalski TE, Shahid H, O’Donnell S, Tolin J, Loren DE, et al. False-positive EUS-guided FNA cytology for solid pancreatic lesions. Gastrointest Endosc. 2011;74(3):535–40.

    Article  PubMed  Google Scholar 

  68. Jhala N, Jhala D, Vickers SM, Eltoum I, Batra SK, Manne U, et al. Biomarkers in diagnosis of pancreatic carcinoma in fine-needle aspirates: a translational research application. Am J Clin Pathol. 2006;126(4):572–9.

    Article  CAS  PubMed  Google Scholar 

  69. Ibrahim DA, Abouhashem NS. Diagnostic value of IMP3 and mesothelin in differentiating pancreatic ductal adenocarcinoma from chronic pancreatitis. Pathol Res Pract. 2016;212(4):288–93.

    Article  CAS  PubMed  Google Scholar 

  70. Chiba M, Imazu H, Kato M, Ikeda K, Arakawa H, Kato T, et al. Novel quantitative analysis of the S100P protein combined with endoscopic ultrasound-guided fine needle aspiration cytology in the diagnosis of pancreatic adenocarcinoma. Oncol Rep. 2017;37(4):1943–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Aksoy-Altinboga A, Baglan T, Umudum H, Ceyhan K. Diagnostic value of S100p, IMP3, Maspin, and pVHL in the differantial diagnosis of pancreatic ductal adenocarcinoma and normal/chronic pancreatitis in fine needle aspiration biopsy. J Cytol. 2018;35(4):247–51.

    PubMed  PubMed Central  Google Scholar 

  72. Sweeney J, Rao R, Margolskee E, Goyal A, Heymann JJ, Siddiqui MT. Immunohistochemical staining for S100P, SMAD4, and IMP3 on cell block preparations is sensitive and highly specific for pancreatic ductal adenocarcinoma. J Am Soc Cytopathol. 2018;7(6):318–23.

    Article  PubMed  Google Scholar 

  73. Layfield LJ, Ehya H, Filie AC, Hruban RH, Jhala N, Joseph L, et al. Utilization of ancillary studies in the cytologic diagnosis of biliary and pancreatic lesions: the papanicolaou society of cytopathology guidelines for pancreatobiliary cytology. Diagn Cytopathol. 2014;42(4):351–62.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Deng H, Shi J, Wilkerson M, Meschter S, Dupree W, Lin F. Usefulness of S100P in diagnosis of adenocarcinoma of pancreas on fine-needle aspiration biopsy specimens. Am J Clin Pathol. 2008;129(1):81–8.

    Article  PubMed  Google Scholar 

  75. Monges GM, Mathoulin-Portier MP, Acres RB, Houvenaeghel GF, Giovannini MF, Seitz JF, et al. Differential MUC 1 expression in normal and neoplastic human pancreatic tissue. An immunohistochemical study of 60 samples. Am J Clin Pathol. 1999;112(5):635–40.

    Article  CAS  PubMed  Google Scholar 

  76. Tokumitsu T, Sato Y, Yamashita A, Moriguchi-Goto S, Kondo K, Nanashima A, et al. Immunocytochemistry for Claudin-18 and Maspin in biliary brushing cytology increases the accuracy of diagnosing pancreatobiliary malignancies. Cytopathology. 2017;28(2):116–21.

    Article  CAS  PubMed  Google Scholar 

  77. Henkes DN, Patel SN, Rosenkranz LA, Escobedo JL. The utility of UroVysion fluorescence in situ hybridization in pancreatic fine-needle aspiration samples directed and obtained by endoscopic ultrasonography. Arch Pathol Lab Med. 2013;137(1):64–71.

    Article  CAS  PubMed  Google Scholar 

  78. Zhang L, Chari S, Smyrk TC, Deshpande V, Klöppel G, Kojima M, et al. Autoimmune pancreatitis (AIP) type 1 and type 2: an international consensus study on histopathologic diagnostic criteria. Pancreas. 2011;40(8):1172–9.

    Article  CAS  PubMed  Google Scholar 

  79. Deshpande V, Mino-Kenudson M, Brugge WR, Pitman MB, Fernandez-del Castillo C, Warshaw AL, et al. Endoscopic ultrasound guided fine needle aspiration biopsy of autoimmune pancreatitis: diagnostic criteria and pitfalls. Am J Surg Pathol. 2005;29(11):1464–71.

    Article  PubMed  Google Scholar 

  80. Holmes BJ, Hruban RH, Wolfgang CL, Ali SZ. Fine needle aspirate of autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis): cytomorphologic characteristics and clinical correlates. Acta Cytol. 2012;56(3):228–32.

    Article  PubMed  Google Scholar 

  81. Morishima T, Kawashima H, Ohno E, Yamamura T, Funasaka K, Nakamura M, et al. Prospective multicenter study on the usefulness of EUS-guided FNA biopsy for the diagnosis of autoimmune pancreatitis. Gastrointest Endosc. 2016;84(2):241–8.

    Article  PubMed  Google Scholar 

  82. Deshpande V, Zen Y, Chan JK, Yi EE, Sato Y, Yoshino T, et al. Consensus statement on the pathology of IgG4-related disease. Mod Pathol. 2012;25(9):1181–92.

    Article  PubMed  Google Scholar 

  83. Conway AB, Cook SM, Samad A, Attam R, Pambuccian SE. Large platelet aggregates in endoscopic ultrasound-guided fine-needle aspiration of the pancreas and peripancreatic region: a clue for the diagnosis of intrapancreatic or accessory spleen. Diagn Cytopathol. 2013;41(8):661–72.

    Article  PubMed  Google Scholar 

  84. Roland CF, van Heerden JA. Nonpancreatic primary tumors with metastasis to the pancreas. Surg Gynecol Obstet. 1989;168(4):345–7.

    CAS  PubMed  Google Scholar 

  85. Pang JC, Roh MH. Metastases to the pancreas encountered on endoscopic ultrasound-guided, fine-needle aspiration. Arch Pathol Lab Med. 2015;139(10):1248–52.

    Article  PubMed  Google Scholar 

  86. Layfield LJ, Hirschowitz SL, Adler DG. Metastatic disease to the pancreas documented by endoscopic ultrasound guided fine-needle aspiration: a seven-year experience. Diagn Cytopathol. 2012;40(3):228–33.

    Article  PubMed  Google Scholar 

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Nga, M.E. (2021). Approach to Endoscopic Ultrasound-Guided FNA of the Gastrointestinal Tract and Pancreas. In: Practical Diagnostic Approaches in Non-Gynaecologic Cytology. Springer, Singapore. https://doi.org/10.1007/978-981-15-2961-0_8

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