Figure 1. Frequency of fine-needle aspirations (FNAs) of the pancreas at the University of Alabama at Birmingham. Note the sharp increase in endoscopic ultrasound (EUS)-guided FNA of pancreas since the institution of the EUS-FNA service in 2000.

Figure 2. ThinPrep (Cytyc, Boxborough, MA) preparation of endoscopic ultrasound-guided fine-needle aspiration sample from the pancreas showing large, single, pleomorphic cells with an increased nuclear/cytoplasmic ratio, some with prominent nucleoli, and a cell with mucin vacuole in the cytoplasm (Papanicolaou, ×40).

Figure 3. Endoscopic ultrasound-guided fine-needle aspiration sample from a case of chronic pancreatitis that shows a cohesive 2-dimensional group of ductal epithelial cells. Individual cells show a preserved nuclear/cytoplasmic ratio and regular nuclear membrane (Papanicolaou, ×40).

Figure 4. Smear reveals cohesive superficial glandular cells of the stomach mucosa. The cells have a preserved nuclear/cytoplasmic ratio. These cells were obtained while aspirating a celiac lymph node using the transgastric approach (rapid Romanowsky, ×40).

Figure 5. This markedly cellular aspirate shows single cells with anisocytosis and eccentrically placed nuclei with evenly dispersed chromatin and occasional cells with conspicuous nucleoli obtained by endoscopic ultrasound-guided fine-needle aspiration of an islet cell tumor of the pancreas (Papanicolaou, ×20).

Figure 6. The smear reveals pools of mucin and a large, cohesive group of epithelial cells with papillary arrangement; the sample was obtained by endoscopic ultrasound-guided fine-needle aspiration of an intraductal papillary mucinous tumor of the pancreas (rapid Romanowsky, ×10).

Figure 7. Endoscopic ultrasound-guided fine-needle aspiration sample of the pancreas from a patient with history of renal cell carcinoma. The smear reveals group of cells with abundant clear cytoplasm and nuclei with nuclear membrane irregularity (rapid Romanowsky, ×40).

Figure 8. A smear from aspiration of a celiac lymph node from a patient with esophageal carcinoma reveals a cohesive group of malignant cells with an increased nuclear/cytoplasmic ratio and metastatic adenocarcinoma cells; the sample is from a patient with a history of gastroesophageal carcinoma (rapid Romanowsky, ×40).

Figure 9. This smear from a celiac lymph node aspirate obtained by endoscopic ultrasound-guided fine-needle aspiration in a patient treated with adjuvant chemotherapy and radiation therapy for esophageal carcinoma shows a paucicellular aspirate with large areas of myxoid change (rapid Romanowsky, ×10).

Figure 10. The cellular aspirate from a gastrointestinal stromal tumor obtained from a duodenal mass reveals sheets of spindled cells with wispy cytoplasm. The nuclei are elongated with some showing nuclear angulation (rapid Romanowsky, ×20).

Figure 11. Endoscopic ultrasound-guided fine-needle aspiration sample from a patient with a history of endometriosis and a mass in the bowel wall reveals tightly cohesive, small glandular cells reminiscent of endometrial cells. In addition, macrophages, some with pigment, also are identified (rapid Romanowsky, ×20).

Figure 12. This smear from a patient with history of pancreatic carcinoma was aspirated from liver lesions (adenocarcinoma metastatic to the liver). The cells show marked pleomorphism with anisocytosis. Individual cells show an enlarged nucleus with an altered nuclear/cytoplasmic ratio. Nuclear membrane irregularity is noted in the large cells (rapid Romanowsky, ×40).

Figure 13. This ThinPrep (Cytyc, Boxborough, MA) sample was obtained by endoscopic ultrasound-guided fine-needle aspiration of a mass in the second portion of the biliary duct. The cells show loosely cohesive groups with occasional single cells. A marked variation in cell size is noted. Individual cells reveal an altered nuclear/cytoplasmic ratio, prominent nucleoli, and an irregular nuclear membrane. This aspirate is from a patient with cholangiocarcinoma (Papanicolaou, ×40).

Figure 14. A sample obtained by endoscopic ultrasound-guided fine-needle aspiration of the left adrenal gland reveals individual cells, some without cytoplasm, lying in the lipid rich background. The cytoplasm of cells reveals lipid vacuolation. The nuclei are small and round with a regular nuclear membrane (rapid Romanowsky, ×20).