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Presented by Ralph Hruban, M.D. and prepared by Orin Buetens, M.D.
Case 3: 42-year-old male with a history of a cystic mass of the head of the pancreas which was resected.
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Question 1 of 1
1. Question
Week 28: Case 3
42-year-old male with a history of a cystic mass of the head of the pancreas which was resected. Now has a cystic mass in the tail of the pancreas./images/1884a.jpg
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/images/1884d.jpgCorrect
Answer: Intraductal papillary mucinous neoplasm with in situ adenocarcinoma
Histology: The histologic findings of this case is similar to Case #4 from Week 11. This cystic tumor is composed of papillary fronds of mucin-producing epithelial cells. Significant nuclear atypia is seen. In addition, this particular case shows pools of acellular mucin (image 3) and extension of the papillary mucinous epithelium into an adherent portion of stomach (image 4).
Discussion: This intraductal papillary mucinous neoplasm with insitu carcinoma was associated with acellular pools of mucin embedded in the stroma. These acellular pools of mucin presumably represent “ruptured” ducts and do not indicate the presence of an invasive cancer. In addition, this particular IPMN has formed a fistula tract into an inherent portion of stomach. This portion of stomach presumably became adherent to the pancreas following the patient’s previous surgery. In this particular case, we believe that this fistula is tramatic in origin and does not indicate a presence of an invasive cancer. More commonly in IPMNs, one sees extension of the IPMN into the major and minor pancreatic ducts and even onto the surface of the duodenum. Again, this intraepithelial extension should not be mistaken for tissue invasion.
Incorrect
Answer: Intraductal papillary mucinous neoplasm with in situ adenocarcinoma
Histology: The histologic findings of this case is similar to Case #4 from Week 11. This cystic tumor is composed of papillary fronds of mucin-producing epithelial cells. Significant nuclear atypia is seen. In addition, this particular case shows pools of acellular mucin (image 3) and extension of the papillary mucinous epithelium into an adherent portion of stomach (image 4).
Discussion: This intraductal papillary mucinous neoplasm with insitu carcinoma was associated with acellular pools of mucin embedded in the stroma. These acellular pools of mucin presumably represent “ruptured” ducts and do not indicate the presence of an invasive cancer. In addition, this particular IPMN has formed a fistula tract into an inherent portion of stomach. This portion of stomach presumably became adherent to the pancreas following the patient’s previous surgery. In this particular case, we believe that this fistula is tramatic in origin and does not indicate a presence of an invasive cancer. More commonly in IPMNs, one sees extension of the IPMN into the major and minor pancreatic ducts and even onto the surface of the duodenum. Again, this intraepithelial extension should not be mistaken for tissue invasion.
