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Presented by Hind Nassar, M.D. and prepared by ChanJuan Shi, M.D., Ph.D.
Case 2: 26 year old woman with parapancreatic mass.
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Question 1 of 1
1. Question
Week 379: Case 2
26 year old woman with parapancreatic massimages/nassar012609-2a.jpg
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images/nassar012609-2d.jpgCorrect
Answer: Neurofibroma
Histology: The tumor is composed of spindle cells with mostly wavy dark staining nuclei, in a myxoid and fibrotic background. Scattered lymphocytes and mast cells are seen. In few areas, mainly where the stroma is fibrotic, there are cells with large irregular and atypical nuclei. No mitotic figures or necrosis are seen.
Discussion: The lesion is classified as neurofibroma with focal cellular atypia. These lesions are benign and should be differentiated from MPNST, which occurs mainly in a background of neurofibroma in the setting of Neurofibromatosis. MPNST is more cellular, displays increased mitotic activity and areas of necrosis. Few authors advocate the use of p53 (<5% in neurofibroma; 10-16% in MPNST) and Ki-67 (<10% in neurofibroma; 32-42% in MPNST) as helpful tools in the differential diagnosis.
Incorrect
Answer: Neurofibroma
Histology: The tumor is composed of spindle cells with mostly wavy dark staining nuclei, in a myxoid and fibrotic background. Scattered lymphocytes and mast cells are seen. In few areas, mainly where the stroma is fibrotic, there are cells with large irregular and atypical nuclei. No mitotic figures or necrosis are seen.
Discussion: The lesion is classified as neurofibroma with focal cellular atypia. These lesions are benign and should be differentiated from MPNST, which occurs mainly in a background of neurofibroma in the setting of Neurofibromatosis. MPNST is more cellular, displays increased mitotic activity and areas of necrosis. Few authors advocate the use of p53 (<5% in neurofibroma; 10-16% in MPNST) and Ki-67 (<10% in neurofibroma; 32-42% in MPNST) as helpful tools in the differential diagnosis.
