Endoscopic Ultrasound Guided Fine Needle Aspiration/Biopsy and Cell Block in Indeterminate Serous Cyst Adenoma, Pancreas: Clinicoradiologic and Cytopathologic Study

INTRODUCTION: Serous cystadenoma (SCA), pancreas is a rare benign neoplasm comprising < 1% of primary pancreatic lesions. Although preoperative imaging and biochemical cyst fluid analysis have been described for SCA, the pathognomic features are appreciable only in a handful of cases. Endoscopic ultrasound guided fine needle aspiration/Biopsy (EUS FNA/B) and cell block of SCA suffers from low cellular yield and nonspecific diagnosis. MATERIAL AND METHODS: This was a combined retrospective and prospective study conducted during a period of 6 years (January 2017-December 2023) at a tertiary care referral centre. Clinical history, primary imaging and EUS characteristics were noted. Immunohistochemical (IHC) expression of alpha inhibin, Calponin, Glucose transporter 1 (GLUT 1), Synaptophysin and Chromogranin was evaluated in the cases of SCA and compared with expression of these immunomarkers in 20 cases of neuroendocrine tumour, pancreas (Grades I and II). RESULTS: Fourteen cases of indeterminate SCA were identified over a period of 6 years (January 2017-December 2023). Cell block supplemented with immunohistochemistry(IHC) was able to provide a definitive diagnosis in 92.3% (12/13) cases in this series. Thus, diagnostic certainty improved from 30.8% on the basis of morphology alone to 92.3% with FNA/B and cell block and IHC. CONCLUSION: Thus, EUS FNA/B supplemented with cell block and IHC can provide an unequivocal preoperative diagnosis of SCA. IHC panel comprising alpha inhibin, GLUT 1, synaptophysin and chromogranin can provide a sufficient level of evidence to categorize the lesion as SCA.