Pancreatic fine needle aspiration cytopathology has earned a reputation as a rapid, safe, accurate and cost-beneficial modality of investigation of pancreatic mass lesion. Optimal results can be expected only if these procedures are undertaken regularly in gastroenterology departments processing large numbers of patients; occasional aspirators cannot exploit the technique to full potential. Professional teams following a dedicated approach to patient selection and management develop requisite expertise over time. Cytodiagnosis rests as much on morphological examination as on the milieu in which is it practised, and as much on sample quality as on cellular criteria. This article focuses attention on specimen handling, with particular reference to rapid on-site evaluation. The significance of particular cytodiagnoses in patient care is evaluated, and tumour types that may be encountered are enumerated and illustrated.

My approach to pancreatic fine needle aspiration

Significant obstructive jaundice in chronic pancreatitis is generally considered to be rare. Eleven of 57 consecutive patients with proven chronic pancreatitis have developed significant obstructive jaundice of more than transient duration. Eight presented as jaundice complicating known pancreatitis and three as jaundice of unknown cause. Life table analysis showed a steady rise in the risk of developing jaundice up to the end of 10 years from the onset of chronic pancreatitis. Jaundice was found to occur in the presence of more "destructive" disease, and jaundiced patients had a higher incidence of pancreatic calcification, diabetes and malabsorption at the time of presentation with jaundice. Obstructive jaundice caused by chronic pancreatitis was found to carry a good prognosis for jaundice, for pain and for life. Only one of the 11 patients died in hospital. It is important to distinguish chronic pancreatitis from cancer in these patients. Pre-operative and intra-operative cytology have been helpful. Stent insertion is not an appropriate method of treatment for these patients because of the benign nature of the disease and the possibility of exacerbating the pancreatitis. It is important to be aware of another form of "malignant masquerade" causing obstructive jaundice.

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Obstructive jaundice in chronic pancreatitis.

sodium contents, without any limitation of energy content. A follow on milk enables a mother to adopt a healthy eating policy for her family without any risk of compromising the energy intake of her growing toddler. Milk is only part of the diet, however, and many other foods that toddlers eatparticularly fast foods-could result in very high intakes of saturated fat and sodium. The follow on formulas in Britain all have reduced saturated fat content, but this will not be compulsory if the draft European Community directive becomes law; some European follow on formulas contain mostly cows' milk fat.

https://www.bmj.com/content/bmj/301/6755/775.full.pdf

Diagnosing cancer of the pancreas.

Significant obstructive jaundice in chronic pancreatitis is generally considered to be rare. Eleven of 57 consecutive patients with proven chronic pancreatitis have developed significant obstructive jaundice of more than transient duration. Eight presented as jaundice complicating known pancreatitis and three as jaundice of unknown cause. Life table analysis showed a steady rise in the risk of developing jaundice up to the end of 10 years from the onset of chronic pancreatitis. Jaundice was found to occur in the presence of more "destructive" disease, and jaundiced patients had a higher incidence of pancreatic calcification, diabetes and malabsorption at the time of presentation with jaundice. Obstructive jaundice caused by chronic pancreatitis was found to carry a good prognosis for jaundice, for pain and for life. Only one of the 11 patients died in hospital. It is important to distinguish chronic pancreatitis from cancer in these patients. Pre-operative and intraoperative cytology have been helpful. Stent insertion is not an appropriate method of treatment for these patients because of the benign nature of the disease and the possibility of exacerbating the pancreatitis. It is important to be aware of another form of "malignant masquerade" causing obstructive jaundice.

Obstructivejaundice in chronic pancreatitis

Fifty-eight cases of pancreatic mass lesions investigated by fine needle aspiration biopsy (FNAB) are reported Biopsies were performed either at laparotomy or percutaneously using ultrasound or computer to mography scanning as a guide Twenty-seven biopsies were reported as consistent with or highly suspicious of adenocarcinoma of the pancreas; five with metastatic carcinoma, one with lymphoma and two with islet cell tumours Nineteen patients had negative biopsies The false-negative rate was 11% and four biopsies were unsatisfactory There were no false-positive diagnoses FNAB is an effective way to obtain cytological confirmation of a pancreatic mass lesion

S. Lep. Langlois

Papers

The diagnosis of mass lesions in the pancreas by fine needle aspiration biopsy