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Presented by Ralph Hruban, M.D. and prepared by Zarir E. Karanjawala, M.D., Ph.D.
Case 4: This elderly smoker developed obstructive jaundice.
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1. Question
Week 345: Case 4
This elderly smoker developed obstructive jaundice. Imaging revealed a pancreatic mass. The mass was resected.images/hruban032408_4a.jpg
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images/hruban032408_4c.jpg
images/hruban032408_4d.jpgCorrect
Answer: Carcinoma metastatic to the pancreas
Histology: This neoplasm is composed of poorly differentiated epithelial cells. The cells form infiltrative nests and cords. The nuclei are large, open and pleomorphic. The cytoplasm of the neoplastic cells is amphophilic. Gland formation is not seen.
Discussion: A metastasis should be considered whenever one encounters a neoplasm in an organ that just doesn’t seem to “fit” into the spectrum of neoplasms that typically arise in that organ. In the case presented, the neoplasm does not match any of the common tumors of the pancreas (acinar, ductal, etc). An immunohistochemical panel was performed to define the direction of differentiation in this case. The neoplasm showed nuclear labeling with antibodies to TTF-1, suggesting that this carcinoma was a metastasis from a lung primary. Subsequent imaging revealed a lung mass.
Incorrect
Answer: Carcinoma metastatic to the pancreas
Histology: This neoplasm is composed of poorly differentiated epithelial cells. The cells form infiltrative nests and cords. The nuclei are large, open and pleomorphic. The cytoplasm of the neoplastic cells is amphophilic. Gland formation is not seen.
Discussion: A metastasis should be considered whenever one encounters a neoplasm in an organ that just doesn’t seem to “fit” into the spectrum of neoplasms that typically arise in that organ. In the case presented, the neoplasm does not match any of the common tumors of the pancreas (acinar, ductal, etc). An immunohistochemical panel was performed to define the direction of differentiation in this case. The neoplasm showed nuclear labeling with antibodies to TTF-1, suggesting that this carcinoma was a metastasis from a lung primary. Subsequent imaging revealed a lung mass.
