Signet-Ring Cell Pattern in Pancreatic Juice Cytology Indicates Intestinal-Type Intraductal Papillary Mucinous Neoplasm with High-Grade Dysplasia or Invasive Carcinoma

Authors:
  • YOYuki Obara
    Yuki Obara
  • YTYosuke Tajika
    Yosuke Tajika
  • MOMegumi Orita
    Megumi Orita
  • KIKazuto Ikeda
    Kazuto Ikeda
  • AHAkiko Hashimoto
    Akiko Hashimoto
  • AHAyumi Hagiwara
    Ayumi Hagiwara
  • YYYui Yoshida
    Yui Yoshida
  • MFMari Fujioka
    Mari Fujioka
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Abstract
Introduction: Signet-ring cells (SRCs) or SRC-like cells are a characteristic cytological feature observed in several malignancies. However, the diagnostic significance of SRC-like cells, including SRCs, in intraductal papillary mucinous neoplasms (IPMNs) remains unclear. Therefore, this study aimed to evaluate the diagnostic significance of SRC-like cells in pancreatic juice cytology (PJC) of patients with IPMN. Methods: We retrospectively analyzed the prevalence, quantity, and mucus coloration of SRC-like cells in PJC specimens from 63 patients with IPMN, categorized by the histological grade and subtype. Results: SRC-like cells were observed in 5.0% (1/20) of low-grade dysplasia, 26.9% (7/26) of high-grade dysplasia (HGD), and 47.1% (8/17) of invasive carcinoma (IC) cases. Based on receiver operating characteristic curve analysis, the presence of ≥30 SRC-like cells (termed the “SRC pattern”) was identified as the optimal threshold for diagnosing HGD/IC, demonstrating 100% specificity and positive predictive value. Among the 16 patients with SRC-like cells, the histological subtypes were gastric (n = 4) and intestinal (n = 12). Gastric-type IPMN cases showed <30 SRC-like cells with yellow to orange mucus, whereas intestinal-type IPMN cases showed ≥30 SRC-like cells with clear to pink mucus. Conclusions: SRC pattern, defined as the presence of ≥30 SRC-like cells in PJC, may be a supportive cytological finding for diagnosing IPMN with HGD/IC, particularly the intestinal subtype. Furthermore, the mucus coloration of SRC-like cells might reflect subtype-related morphological tendencies.

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