Endoscopic Ultrasound-Guided Fine-Needle Aspiration for the Diagnosis of Anaplastic Pancreatic Carcinoma

OBJECTIVES: Anaplastic carcinoma of the pancreas (ACP) is an aggressive variant of ductal adenocarcinoma. The aim of this study was to describe a single-center experience with the use of endoscopic ultrasound (EUS) with or without fine-needle aspiration (FNA) for the diagnosis of ACP. METHODS: The cytology and surgical pathology databases were searched for a diagnosis of ACP between 1992 and 2008. Demographic, clinical,surgical, radiographic, pathological, and EUS data were abstracted. RESULTS: Thirteen patients with ACP were identified, which represented 0.8% of all pancreatic cancers diagnosed during the study period. Six of 13 patients had EUS. Features of these 6 tumors: median diameter of 42 mm (range, 20-100 mm), hypoechoic (n = 6), solid (n = 3) or mixed solid and cystic (n = 3), heterogeneous (n = 5) or homogeneous (n = 1),and well defined (n = 2) or poorly defined (n = 4) borders. Five underwent EUS-FNA of a pancreatic mass, and cytology demonstrated ACP in 4 and ductal adenocarcinoma in 1. The diagnosis of ACP was confirmed after surgical resection in 2 of these 5, including one in whom cytology demonstrated only adenocarcinoma. The sixth patient had EUS without FNA, and surgical pathology after distal pancreatectomy found ACP. CONCLUSIONS: Anaplastic carcinoma of the pancreas has variable endosonographic features. Endoscopic ultrasound-FNA may assist in the cytological diagnosis of these tumors.