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Presented by Ralph Hruban, M.D. and prepared by Hillary Elwood, M.D.
Case 1: This newborn was found to have a large cystic mass of the pancreas.
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1. Question
Week 477: Case 1
This newborn was found to have a large cystic mass of the pancreas. The lesion was surgically resected.images/1alex/05092011case1image1.jpg
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images/1alex/05092011case1image5.jpgCorrect
Answer: Juvenile hemangioma
Histology: The normal pancreatic parenchyma is preserved, but distorted by vascular channels interspersed among the normal elements.
Discussion: This is a very unusual case. The first clue to the diagnosis is the low magnification appearance of the pancreas. The lobular architecture is preserved. At higher magnification one can appreciate normal acini and normal ducts. They lack atypia. Slit-like spaces lined by flattened cells separate the cells. Immunolabeling revealed that these express CD31 and CD34.
Hemangiomas and lymphangiomas can involve the pancreas, but they usually produce discrete, sometimes even exophytic, masses. This case is unusual because it so intimately involves the parenchyma of the gland.
Incorrect
Answer: Juvenile hemangioma
Histology: The normal pancreatic parenchyma is preserved, but distorted by vascular channels interspersed among the normal elements.
Discussion: This is a very unusual case. The first clue to the diagnosis is the low magnification appearance of the pancreas. The lobular architecture is preserved. At higher magnification one can appreciate normal acini and normal ducts. They lack atypia. Slit-like spaces lined by flattened cells separate the cells. Immunolabeling revealed that these express CD31 and CD34.
Hemangiomas and lymphangiomas can involve the pancreas, but they usually produce discrete, sometimes even exophytic, masses. This case is unusual because it so intimately involves the parenchyma of the gland.
