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Presented by Ralph Hruban, M.D. and prepared by Matthew Karafin, M.D.
Case 2: This patient had a distal pancreatectomy for adenocarcinoma of the pancreas.
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Question 1 of 1
1. Question
Week 503: Case 2
This patient had a distal pancreatectomy for adenocarcinoma of the pancreas. The image is from the margin of resection.images/1alex/103111case2image1.jpg
images/1alex/103111case2image2.jpg
images/1alex/103111case2image3.jpgCorrect
Answer: Invasive ductal adenocarcinoma
Histology: This high power view shows a gland with striking pleomorphism. The area of the nuclei vary by >4 to 1 in this single duct (image 2 and 3).
Discussion: There are six features that can be used to distinguish benign glands from invasive adenocarcinoma. They are:
1) perineural invasion;
2) vascular invasion,
3) a gland immediately adjacent to a muscular artery;
4) haphazard growth of the glands;
5) luminal necrosis and incomplete lumina; and
6) the “4 to 1 rule.” This later feature is met when the area of the nuclei in a single gland vary by more than 4 to 1.This case meets the 4 to 1 rule and was called invasive adenocarcinoma. Of course, no rule is perfect, or as Barbossa said in the Priates of the Caribbean, “the [priate] code is more what you’d call guidelines than actual rules.” Take all of the features of a case into consideration before establishing a diagnosis of cancer.
Incorrect
Answer: Invasive ductal adenocarcinoma
Histology: This high power view shows a gland with striking pleomorphism. The area of the nuclei vary by >4 to 1 in this single duct (image 2 and 3).
Discussion: There are six features that can be used to distinguish benign glands from invasive adenocarcinoma. They are:
1) perineural invasion;
2) vascular invasion,
3) a gland immediately adjacent to a muscular artery;
4) haphazard growth of the glands;
5) luminal necrosis and incomplete lumina; and
6) the “4 to 1 rule.” This later feature is met when the area of the nuclei in a single gland vary by more than 4 to 1.This case meets the 4 to 1 rule and was called invasive adenocarcinoma. Of course, no rule is perfect, or as Barbossa said in the Priates of the Caribbean, “the [priate] code is more what you’d call guidelines than actual rules.” Take all of the features of a case into consideration before establishing a diagnosis of cancer.
