Eltoum et al used a cytologic grading system to evaluate patients with pancreatic adenocarcinoma. This can help identify patients who may require more aggressive management. The authors are from the University of Alabama at Birmingham.
Cytologic features of pancreatic adenocarcinoma:
(1) anisonucleosis
(2) cellular groups showing nuclear crowding and overlapping ("drunken honeycomb")
(3) nuclear enlargement (nuclear size greater than 2.5 times the diameter of an RBC; the diameter of an RBC is about 7.8 microns)
(4) irregular nuclear outline
(5) singly scattered malignant cells in the background
Parameters used for grading:
(1) cellular groups
(2) singly scattered malignant cells
(3) nuclear grade
(4) mucus
(5) necrosis
(6) bizarre cells (epithelial cells with nuclear diameters more than 6 times that of an RBC, nuclear membrane irregularities and multinucleation/multilobulation)
Nuclear Size |
Irregularity |
Variation |
Nuclear Grade |
2.5-3 times RBC |
slightly |
minimal |
low |
> 3 times RBC |
slightly |
marked |
intermediate |
> 3 times RBC |
markedly |
marked |
high |
Parameter |
Finding |
Points |
cellular groups |
"drunken" honeycomb" |
0 |
|
discohesive clumps with 3 dimensions, falling apart |
1 |
single malignant cells |
few |
0 |
|
moderate |
1 |
|
many |
2 |
nuclear grade |
low |
0 |
|
intermediate |
1 |
|
high |
2 |
mucus |
none |
1 |
|
present |
0 |
necrosis |
none |
0 |
|
present |
1 |
bizarre cells |
none |
0 |
|
present |
1 |
total score =
= SUM(points for all 6 factors)
Interpretation:
• minimum score: 0
• maximum score: 8
• A high score indicates a high grade adenocarcinoma.
Total Score |
Tumor Grade |
Median Survival |
0 or 1 |
low grade |
12 months |
2 to 8 |
high grade |
6 months |
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,