Case ReviewsThe Role of Molecular Testing in the Workup of Pancreatic CystsDeftereos, Georgios MD*; Finkelstein, Sydney D. MD†; Jackson, Sara A. PhD†; Silverman, Jan F. MD*Author Information From the *Department of Pathology and Laboratory Medicine, Allegheny General Hospital; and ‡RedPath Integrated Pathology, Pittsburgh, PA. Reprints: Georgios Deftereos, MD, Department of Pathology and Laboratory Medicine, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212. E-mail: [email protected]. S.D.F. and S.A.J. are employees of RedPath Integrated Pathology, Inc, Pittsburgh, PA. The other authors have no funding or conflicts to declare. Pathology Case Reviews: January/February 2014 - Volume 19 - Issue 1 - p 22-27 doi: 10.1097/PCR.0000000000000018 Buy Metrics Abstract Pancreatic cysts are diverse and common lesions that vary in clinical, radiological, and pathological characteristics and are extremely common, affecting approximately 2.6% of asymptomatic adults while reaching a frequency of more than 8% in people older than 80 years.1 Most cysts are benign, even though many are mucinous.2,3 Because not all mucinous cysts are malignant, recognizing the malignant potential for mucinous cysts is of paramount importance. While recent advancements in imaging provide a valuable aid in the differential diagnosis of mucinous and nonmucinous cysts, significant overlap exists.4–6 Cytological evaluation is the first step in the assessment of the pancreatic cyst fluid; however, it is often hampered by high rates of false-negative and indeterminate diagnoses, due mainly to hypocellular or acellular specimens. Biochemical and molecular analysis of pancreatic cyst fluid can be extremely helpful in the assessment of pancreatic cystic lesions. Recent advancements in the understanding of the molecular mechanisms of pancreatic carcinogenesis may lead to more accurate diagnosis. We present a recent case seen in the authors’ practice that illustrates how integrating molecular testing in routine pancreatic cytology can lead to improvement in the pathologist’s capacity to diagnose pancreatic cystic lesions. We provide a brief review of the added value of an integrated, morphobiologic approach to pancreatic cytology. © 2014 by Lippincott Williams & Wilkins.