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Presented by Ralph Hruban, M.D. and prepared by Zarir E. Karanjawala, M.D., Ph.D.
Case 6: This elderly man complained of a vague sense of abdominal fullness.
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1. Question
Week 345: Case 6
This elderly man complained of a vague sense of abdominal fullness. A CAT scan revealed a large mass intimately associated with the pancreas. A pancreatectomy was performed.images/hruban032408_6a.jpg
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images/hruban032408_6e.jpgCorrect
Answer: Gastrointestinal stromal tumor
Histology: This large spindle cell neoplasm abutted the pancreas. The neoplastic cells have abundant pink cytoplasm, although some show prominent vacuolization. Mitoses are not prominent.
Discussion: A variety of spindle cell neoplasms can involve the pancreas. These include benign lesions such as the schwannoma and leiomyoma, and more aggressive neoplasms such a fibromatosis, gastrointestinal stromal tumor, and a host of sarcomas. In general, the same criteria should be applied to the diagnosis of a spindle cell neoplasm that involves the pancreas as would be applied to spindle cell neoplasms in other organs or in the soft tissues. In this case the neoplasm labeled strongly with antibodies to CD34 and C-Kit, establishing the diagnosis of a gastrointestinal stromal tumor.
Incorrect
Answer: Gastrointestinal stromal tumor
Histology: This large spindle cell neoplasm abutted the pancreas. The neoplastic cells have abundant pink cytoplasm, although some show prominent vacuolization. Mitoses are not prominent.
Discussion: A variety of spindle cell neoplasms can involve the pancreas. These include benign lesions such as the schwannoma and leiomyoma, and more aggressive neoplasms such a fibromatosis, gastrointestinal stromal tumor, and a host of sarcomas. In general, the same criteria should be applied to the diagnosis of a spindle cell neoplasm that involves the pancreas as would be applied to spindle cell neoplasms in other organs or in the soft tissues. In this case the neoplasm labeled strongly with antibodies to CD34 and C-Kit, establishing the diagnosis of a gastrointestinal stromal tumor.
