56岁female胰腺尾部肿瘤FNA.

 这个病例细胞丰富， 为单个散在的细胞或疏松的细胞团，细胞有浆细胞样形态，核边居，胞质细颗粒状。胞核圆形，有中到重度异型。我想诊断肿瘤没问题，关键是哪一类肿瘤？下面是选择：

A)胰腺导管腺癌 (Ductal Adenocarcinoma)

B)腺泡细胞癌 (Acinic cell carcinoma)

C)胰岛细胞瘤 (Islet cell tumor)

D)实性-假乳头状肿瘤 (Solid Pseudo-papillary neoplasm)

片子很漂亮，特别是第二张就象是仙人所画，应该是我见过的最漂亮的细胞片了。

乳头状结构，细胞多数异型性小，见个别大核，图1染色质较为细腻而致密，图2的染色法则又较为疏松；见浆细胞样细胞。

上皮，神经内分泌，选“D”。

 神经内分泌是正确的。乳头状结构没有出现。这是一例典型的胰岛细胞瘤（Islet cell tumor).

 In most of the American Hospitals now, pancreatic FNAs were done by either Gastroernteologists (through Endoscopic ultrasound guidance) or by radiologists by CT guidance. The Endoscopic Ultrasound guided pancreatic FNAs are more and more popular due to easy access to pancreatic tumors. Cytopathologists are usually present during the FNAs with the Gastroenterologists to give on-site adequacy review to tell them if they get a good sample or not, if yes, they stop the procedure, if no, they will do more FNAs until they get a good sample.

 Acinic cell carcinoma can be confused with islet cell tumor of the pancreas, they usually do not show striking plasmacytoid morphology and they usually have large prominent nucleoli and relatively clear cytoplasm. If in doubt, you can always do immunostains to support your diagnosis.

 Hope these answers are helpful.