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Presented by Ralph Hruban, M.D. and prepared by Rui Zheng, M.D., Ph.D.
Case 2: This elderly patient presented with a long history of vague abdominal pain.
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Question 1 of 1
1. Question
Week 449: Case 2
This elderly patient presented with a long history of vague abdominal pain. Computerized tomography revealed a cystic mass with a solid component. The lesion was resected.images/1alex/08302010case2image1.jpg
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images/1alex/08302010case2image4.jpgCorrect
Answer: Invasive ductal adenocarcinoma arising in association with an intraductal papillary mucinous neoplasm with high-grade dysplasia
Histology: This neoplasm has two components. The first is a high-grade papillary neoplasm growing within the pancreatic ducts. This component lacks an ovarian stroma. The second is a haphazard glandular component in the stroma.
Discussion: This is a great example of an invasive ductal adenocarcinoma arising in association with an intraductal papillary mucinous neoplasm (IPMN). The IPMN was probably there for years before it progressed to an invasive cancer. This would explain the patient’s long history of symptoms. The IPMN is distinguished from a mucinous cystic neoplasm by the absence of ovarian stroma and the intraductal growth. The invasive component is recognized by the extension of cells beyond the normal branching duct system, the haphazard arrangement of the glands, and by the presence of focal perineural invasion.
Incorrect
Answer: Invasive ductal adenocarcinoma arising in association with an intraductal papillary mucinous neoplasm with high-grade dysplasia
Histology: This neoplasm has two components. The first is a high-grade papillary neoplasm growing within the pancreatic ducts. This component lacks an ovarian stroma. The second is a haphazard glandular component in the stroma.
Discussion: This is a great example of an invasive ductal adenocarcinoma arising in association with an intraductal papillary mucinous neoplasm (IPMN). The IPMN was probably there for years before it progressed to an invasive cancer. This would explain the patient’s long history of symptoms. The IPMN is distinguished from a mucinous cystic neoplasm by the absence of ovarian stroma and the intraductal growth. The invasive component is recognized by the extension of cells beyond the normal branching duct system, the haphazard arrangement of the glands, and by the presence of focal perineural invasion.
