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Presented by Ralph Hruban, M.D. and prepared by Shiyama Mudali, M.D.
Case 1: This 50 some year old patient was found to have an asymptomatic mass in the tail of his pancreas.
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Question 1 of 1
1. Question
Week 457: Case 1
This 50 some year old patient was found to have an asymptomatic mass in the tail of his pancreas. The lesion was resected and had a mitotic count of 5 mitoses per 10 hpf and a Ki-67 labeling of 8%.images/1alex/110110case1image1.jpg
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images/1alex/110110case1image5.jpgCorrect
Answer: Neuroendocrine tumor grade 2
Histology: This neoplasm has the typical appearance of a well-differentiated pancreatic endocrine neoplasm, with uniform round nuclei and a “salt and pepper”chromatin. As noted, the mitotic count was 5 mitoses per 10 hpf and the Ki-67 labeling rate was 8%.
Discussion: The new WHO “blue book” is out and non-syndromic neuroendocrine neoplasms of the pancreas are broadly divided into three grades:
A) Neuroendocrine tumor grade 1 is defined as having 0-1 mitoses per 10 hpf and a Ki-67 labeling rate of 0-2%.
B) Neuroendocrine tumor grade 2 is defined as having 2-20 mitoses per 10 hpf and a Ki-67 labeling rate of 3-20%.
C) Neuroendocrine carcinoma has >20mitoses per 10 hpf and a Ki-67 labeling rate of >20%. This tumor had a mitotic count of 5 mitoses per 10 hpf and a Ki-67 labeling rate of 8%, putting it in the neuroendocrine tumor grade 2.Incorrect
Answer: Neuroendocrine tumor grade 2
Histology: This neoplasm has the typical appearance of a well-differentiated pancreatic endocrine neoplasm, with uniform round nuclei and a “salt and pepper”chromatin. As noted, the mitotic count was 5 mitoses per 10 hpf and the Ki-67 labeling rate was 8%.
Discussion: The new WHO “blue book” is out and non-syndromic neuroendocrine neoplasms of the pancreas are broadly divided into three grades:
A) Neuroendocrine tumor grade 1 is defined as having 0-1 mitoses per 10 hpf and a Ki-67 labeling rate of 0-2%.
B) Neuroendocrine tumor grade 2 is defined as having 2-20 mitoses per 10 hpf and a Ki-67 labeling rate of 3-20%.
C) Neuroendocrine carcinoma has >20mitoses per 10 hpf and a Ki-67 labeling rate of >20%. This tumor had a mitotic count of 5 mitoses per 10 hpf and a Ki-67 labeling rate of 8%, putting it in the neuroendocrine tumor grade 2.