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Presented by Ralph Hruban, M.D. and prepared by Marc Lewin, M.D.
Case 3: This middle-aged woman was found to have a mostly solid mass in the head of her pancreas.
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1. Question
Week 296: Case 3
This middle-aged woman was found to have a mostly solid mass in the head of her pancreas./images/1-8-06case3a.jpg
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/images/1-8-06case3e.jpgCorrect
Answer: Well-differentiated pancreatic endocrine neoplasm
Histology: This neoplasm is composed of granular cells with uniform “salt and pepper” nuclei. They surround a prominent vasculature, giving the appearance of papillae.
Discussion: The four main entities to consider in the differential diagnosis of a cellular neoplasm of the pancreas are:
1) acinar cell carcinoma,
2) pancreatoblastoma,
) well-differentiated pancreatic endocrine neoplasm, and
4) solid-pseudopapillary neoplasm.The acinar cell carcinoma and pancreatoblastoma can be eliminated in this case because there is no acinar differentiation. The distinction between a well-differentiated pancreatic endocrine neoplasm and a solid-pseudopapillary neoplasm can be problematic. The presence of foam cells, poorly cohesive cells, and hyaline globules (none of which are seen in this case) would favor a solid-pseudopapillary neoplasm.
In this case, the neoplasm labeled strongly for synaptophysin and showed a membranous pattern of labeling for beta-catenin, establishing the diagnosis.
Incorrect
Answer: Well-differentiated pancreatic endocrine neoplasm
Histology: This neoplasm is composed of granular cells with uniform “salt and pepper” nuclei. They surround a prominent vasculature, giving the appearance of papillae.
Discussion: The four main entities to consider in the differential diagnosis of a cellular neoplasm of the pancreas are:
1) acinar cell carcinoma,
2) pancreatoblastoma,
) well-differentiated pancreatic endocrine neoplasm, and
4) solid-pseudopapillary neoplasm.The acinar cell carcinoma and pancreatoblastoma can be eliminated in this case because there is no acinar differentiation. The distinction between a well-differentiated pancreatic endocrine neoplasm and a solid-pseudopapillary neoplasm can be problematic. The presence of foam cells, poorly cohesive cells, and hyaline globules (none of which are seen in this case) would favor a solid-pseudopapillary neoplasm.
In this case, the neoplasm labeled strongly for synaptophysin and showed a membranous pattern of labeling for beta-catenin, establishing the diagnosis.
