Chapter 14 Answers to discussion questions

Cytology of the biliary tract and pancreas

14.1 How is cholangiocarcinoma diagnosed? Discuss.

Your answers should include the following list. Do mention the limitation of each diagnostic modality.  History and physical exam blood tests, liver function tests, tumour markers (CEA and CA 19-9) Imaging tests: abdominal ultrasound, endoscopic or laparoscopic ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, MR cholangiopancreatography (MRCP),MR angiography (MRA) , endoscopic retrograde cholangiopancreatography (ERCP), laparoscopy, cholangioscopy biopsy and of course don’t forget  cytology.


14.2 Discuss the diagnosis of pancreatic cancer.

The answer to this question is similar to the earlier question above. The tests include abdominal ultrasound, EUS, CT, MRI, MRCP, ERCP, biopsy or cytology, laparoscopy, laparotomy and blood tests.


14.3 Discuss the role of cytology in assessment of biliary and pancreatic lesions.

Cytological techniques have become the favoured diagnostic modality of epithelial sampling as it is difficult to take good quality biopsy of the bile duct lesions. Briefly described the sample types e.g. bile and brush. Briefly discussed the limitation of each sampling technique. Briefly described at the sample is obtained during ERCP. Briefly describe, normal, inflammatory and neoplastic features.


14.4 A 75-year-old male with jaundice underwent EUS guided fine needle aspiration of a 2 cm solid mass in the head of the pancreas. The aspirate included cells arranged in flat sheets with loss of polarity and numerous single cells. Many cells had slightly enlarged nuclei and clear cytoplasm. No acinar arrangements were seen. Discuss the differential diagnosis.

The differential diagnosis given could include reactive duct epithelium, duodenal contaminant and well differentiated adenocarcinoma.

The given descrption is suggestive of a well differentiated adenocarcinoma. Cells of ductal adenocarcinoma are generally larger than the normal counterpart. Loss of polarity is typical of adenocarcinoma and it can be seen as crowding and uneven spacing of atypical cells.


14.5 An EUS guided FNA of pancreatic mass in 40-year-old female reveal abundant single cells with eccentric nuclei. The cells were monotonous, small and with no obvious anisonucleosis. Discuss the differential diagnosis.

Pancreatic endocrine tumour is characterised by increased cellularity with majority of the cells. Chromatin is typically salt and pepper.

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