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Presented by Ralph Hruban, M.D. and prepared by Shiyama Mudali, M.D.
Case 6: This patient presented with diverticulitis. He was otherwise asymptomatic.
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1. Question
Week 457: Case 6
This patient presented with diverticulitis. He was otherwise asymptomatic. A pancreatic mass was found and was resected. The neoplasms had a mitotic count of 3 mitoses per 10 hpf and a Ki-67 labeling rate of 11%.Which of the following is NOT a significant prognostic indicator for pancreatic neuroendocrine tumors?
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Answer: Pleomorphism
Histology: This neuroendocrine tumor has a mitotic count of 3 mitoses per 10 hpf and a Ki-67 labeling rate of 11%. Vascular invasion, nuclear pleomorphism, and tumor necrosis are noted.
Discussion: A number of features have been shown to be prognostically significant with neuroendocrine tumors of the pancreas. In addition to TMN stage, these include the mitotic rate (which determines grade), large vessel invasion, the aberrant expression of cytokeratin 19, and necrosis. Nuclear pleomorphism is not one of them.
Incorrect
Answer: Pleomorphism
Histology: This neuroendocrine tumor has a mitotic count of 3 mitoses per 10 hpf and a Ki-67 labeling rate of 11%. Vascular invasion, nuclear pleomorphism, and tumor necrosis are noted.
Discussion: A number of features have been shown to be prognostically significant with neuroendocrine tumors of the pancreas. In addition to TMN stage, these include the mitotic rate (which determines grade), large vessel invasion, the aberrant expression of cytokeratin 19, and necrosis. Nuclear pleomorphism is not one of them.
