Endoscopic ultrasound-guided fine-needle aspiration cytology in the diagnosis of intraductal papillary mucinous neoplasms of the pancreas. A study of 8 cases.

CONTEXT: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized neoplasm of the pancreas, accounting for 5% of pancreatic neoplasms, it is considered difficult to diagnose by fine-needle aspiration (FNA) cytology. OBJECTIVE: The aim of this study was to investigate the role of EUS-guided FNA cytology in the diagnosis of IPMN of the pancreas. PATIENTS: Eight cases of surgically proven IPMN with pre-operative endoscopic ultrasound-guided (EUS-guided) FNA cytology were collected for retrospective analysis. MAIN OUTCOME MEASURES: EUS-FNA cytology was performed with the on-site attendance of a cytopathologist in all cases. EUS/clinical findings, macroscopic/microscopic features of cell blocks and smears, and immunocytochemical stains accompanied by histopathologic diagnosis were recorded and studied. RESULTS: EUS revealed hypoechoic masses in the head of pancreas (n=6) and in the body/tail (n=2), measuring from 16.6 to 35.8 mm. In all cases, the hypoechoic mass had a distinctive distribution, involving the main pancreatic duct and/or the associated large branch ducts while intraductal nodules or multiple cysts were detected. Cytological specimens were characterized by a background containing abundant mucin in all cases and rarely by inflammation (neutrophils and histiocytes) (n=4). Neoplastic cells were entrapped in a mucinous background either single or loosely cohesive, and forming papillae in 7 cases. Mucinous epithelium was observed in all cases. Single atypical and irregular clusters were found in 3 cases (which were cytologically described as highly suggestive malignant IPMNs, and were histologically confirmed). Two cases were diagnosed as benign IPMN and, in 3 cases, the biological behavior was not easy to determine by cytology alone (histologically diagnosed as borderline). The histological diagnosis confirmed the FNA cytology diagnosis: 3 malignant IPMNs, 2 benign IPMNs and 3 borderline IPMNs. Immunostains were available in 5 out of 8 cases. Mucin 1 (MUC-1) was positive in 2 cases of malignant IPMN (histologically classified as null type ad intestinal type), mucin 2 (MUC-2) was positive in 3 cases (2 malignant both of the intestinal type, and 1 benign of the intestinal type I) and c-erbB2 was positive in 3 cases (2 benign - null and intestinal type - and 1 malignant null type). CONCLUSIONS: The characteristic pre-operative EUS findings and cytomorphologic features, in addition to the immunocytochemical profile, were accurate indications and coincided with the final/post-operative histological diagnosis of IPMN.

Intrafamilial spread of Helicobacter pylori: a genetic analysis.

BACKGROUND: A high incidence of Helicobacter pylori among family members of children with H. pylori gastritis has previously been documented on biopsy material. The main objective of this study was the genetic clarification of H. pylori strains involved in intrafamilial dispersion. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded material of antral mucosa from 32 members of 11 families was studied for the presence of genetic homogeneity. To achieve this goal, the entire genome of H. pylori was studied by the polymerase chain reaction (PCR)-based random amplified polymorphic DNA (RAPD) fingerprinting method. Furthermore, the Urease A gene was analyzed using a multiplex PCR-assay and an alternative mutation detection method based on the Hydrolink trade mark analysis. RESULTS: RAPD fingerprinting confirmed that closely related H. pylori strains were involved in the intrafamilial dispersion. Mutations and small deletions in Urease A gene were found in 22 out of 32 individuals. CONCLUSIONS: The homology of the H. pylori genome in members of the same family strongly supports the hypothesis of transmission of H. pylori from person-to-person or from a common source.