Brian T Collins1, Joshua Warrick. 1. Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110-1093, USA. bcollins@path.wustl.edu
Abstract
OBJECTIVE: Celiac ganglia are normal anatomic structures located in the region of the celiac artery and can vary in size from 5 mm to 4.5 cm. These nodules can be visualized by endoscopic ultrasound (EUS) and be subject to fine needle aspiration (FNA) biopsy. They can be identified in patients with and without underlying pathology and present a challenge in accurate interpretation. STUDY DESIGN: The hospital database was retrospectively searched for patients who had undergone EUS FNA and where a diagnosis of 'ganglia' was rendered. Clinical and demographic data were collected and the cases reviewed for cytomorphologic features. RESULTS: Aspirate smears were generally hypocellular with variable cellularity between aspirate passes, showing dispersed single large epithelioid cells with cytoplasmic pigmentation, small groups of bland stroma and spindled cells, as well as 'grape-like' groups with peripheral epithelioid cells and central stroma with spindled elements. CONCLUSION: EUS cannot always definitively identify celiac lesions and the use of EUS FNA can help to accurately classify these cases. In patients with known or suspected malignancy, the accurate identification of celiac ganglia by EUS FNA can have important patient management implications. EUS FNA can identify celiac ganglia and show the distinctive features of large pigmented epithelioid ganglion cells and background neural elements.
OBJECTIVE: Celiac ganglia are normal anatomic structures located in the region of the celiac artery and can vary in size from 5 mm to 4.5 cm. These nodules can be visualized by endoscopic ultrasound (EUS) and be subject to fine needle aspiration (FNA) biopsy. They can be identified in patients with and without underlying pathology and present a challenge in accurate interpretation. STUDY DESIGN: The hospital database was retrospectively searched for patients who had undergone EUS FNA and where a diagnosis of 'ganglia' was rendered. Clinical and demographic data were collected and the cases reviewed for cytomorphologic features. RESULTS: Aspirate smears were generally hypocellular with variable cellularity between aspirate passes, showing dispersed single large epithelioid cells with cytoplasmic pigmentation, small groups of bland stroma and spindled cells, as well as 'grape-like' groups with peripheral epithelioid cells and central stroma with spindled elements. CONCLUSION: EUS cannot always definitively identify celiac lesions and the use of EUS FNA can help to accurately classify these cases. In patients with known or suspected malignancy, the accurate identification of celiac ganglia by EUS FNA can have important patient management implications. EUS FNA can identify celiac ganglia and show the distinctive features of large pigmented epithelioid ganglion cells and background neural elements.