Introduction: The increasing use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) cytology to examine pancreatic neoplasms has led to an increase in the diagnosis of metastases to the pancreas. Renal cell carcinoma (RCC) is the most common metastasis to the pancreas. Our study examines 33 cases of metastatic RCC to the pancreas sampled by EUS-FNA from four large tertiary care hospitals. Materials and Methods: We searched the cytopathology database for RCC metastatic to the pancreas diagnosed by EUS-FNA from January 2005 to January 2015. Patient age, history of RCC, nephrectomy history, follow-up postnephrectomy, radiological impression, and EUS-FNA cytologic diagnosis were reviewed. Results: Thirty-three patients were identified. The average age was 67.5 years (range, 49–84 years). Thirty-two patients had a previous documented history of RCC. One patient had the diagnosis of pancreatic metastasis at the same time of the kidney biopsy. Thirty-one patients had been treated with nephrectomy. Twenty-seven patients were being monitored annually by computed tomography or magnetic resonance imaging. Twenty-five patients had multiple masses by imaging, but 8 patients had a single mass in the pancreas at the time of EUS-FNA. EUS-FNA of 20 cases showed classic morphology of RCC. Thirteen cases had either “atypical” clinical-radiologic features or morphologic overlaps with primary pancreatic neoplasms or other neoplasms. Cell blocks were made on all 13 cases and immunochemical stains confirmed the diagnosis. Conclusions: EUS-FNA cytology is useful for the diagnosis of metastatic RCC to the pancreas. Cytomorphology can be aided with patient history, imaging analyses, cell blocks, and immunochemical stains.

The distinction of ovarian granulosa cell tumors (GCTs) from other sex-cord stromal tumors may be difficult histologically. Many immunohistochemical markers have been studied for this differential diagnosis, but the available markers are not entirely specific for ovarian GCT. 14-3-3 sigma has been shown to play an anti-apoptotic role in maintaining the viability of immortalized granulosa cells. However, the potential use of this molecule as an immunohistochemical marker for the diagnosis of ovarian GCT has not been investigated. A total of 103 ovarian sex-cord stromal neoplasms were immunostained with 14-3-3 sigma. These tumors included 44 adult granulosa cell, 7 juvenile granulosa cell tumors, 12 steroid cell tumors, 3 well-differentiated Sertoli-Leydig cell tumors, 5 Sertoli cell tumors, 10 thecomas, 18 fibromas, 2 primary ovarian endometrial stromal sarcomas, and 2 unclassified sex-cord stromal tumors. Ten ovaries with cystic follicles were also included as controls. Perinuclear or cytoplasmic stain was considered to be positive. Granulosa cells within the cystic follicles were positive for 14-3-3 sigma protein. All ovarian GCT (51/51) and all steroid cell tumors (12/12) were positive for 14-3-3 sigma, and all Sertoli cell tumors, fibromas, thecomas, ovarian endometrial stromal sarcomas, and sex-cord stromal tumors, unclassified, were negative for 14-3-3 sigma. The percentage of positive cell staining is statistically significant (P<0.0001) between the above 2 groups of sex-cord stromal tumors. These findings provide the initial evidence of the overexpression of 14-3-3 sigma in granulosa cells and steroid-hormone-secreting cells. They further indicate that immunohistochemical staining of 14-3-3 sigma may be a useful marker in facilitating the diagnosis of ovarian GCT and steroid cell tumors.