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Presented by Ralph Hruban, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 4: This elderly male with a history of chronic pancreatitis was found to have a cystic mass in the head of the pancreas.
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1. Question
Week 241: Case 4
This elderly male with a history of chronic pancreatitis was found to have a cystic mass in the head of the pancreas. At the time of endoscopy he was also found to have a prominent accessory ampulla. The specimen is from the accessory ampulla.mages/10 11 05 case 4 1.jpg
mages/10 11 05 case 4 2.jpg
mages/10 11 05 case 4 3.jpg
mages/10 11 05 case 4 4.jpgCorrect
Answer: Intraductal Papillary Mucinous Neoplasm
Histology: A papillary mucin producing epithelial neoplasm can be appreciated extending from the minor pancreatic duct out onto the luminal surface of the accessory ampulla.
Discussion: Intraductal papillary mucinous neoplasms, as the name suggests, arise within the duct system of pancreas. They can extensively grow along the pancreatic duct system and even extend out onto the ampulla of Vater. This case was unusual in that the intraductal papillary mucinous neoplasm extended out and into the accessory ampulla of Vater. Intraductal papillary mucinous neoplasms should be included in the differential diagnosis of a mucin producing papillary epithelial neoplasm in these loci.
Approximately one-third of intraductal papillary mucinous neoplasms are associated with invasive cancer. In half the cases, this invasive cancer is a colloid type of carcinoma while in the other half it is a tubular adenocarcinoma.
Incorrect
Answer: Intraductal Papillary Mucinous Neoplasm
Histology: A papillary mucin producing epithelial neoplasm can be appreciated extending from the minor pancreatic duct out onto the luminal surface of the accessory ampulla.
Discussion: Intraductal papillary mucinous neoplasms, as the name suggests, arise within the duct system of pancreas. They can extensively grow along the pancreatic duct system and even extend out onto the ampulla of Vater. This case was unusual in that the intraductal papillary mucinous neoplasm extended out and into the accessory ampulla of Vater. Intraductal papillary mucinous neoplasms should be included in the differential diagnosis of a mucin producing papillary epithelial neoplasm in these loci.
Approximately one-third of intraductal papillary mucinous neoplasms are associated with invasive cancer. In half the cases, this invasive cancer is a colloid type of carcinoma while in the other half it is a tubular adenocarcinoma.
