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Presented by Ralph Hruban, M.D. and prepared by Robert E LeBlanc, M.D.
Case 2: This middle-aged woman presented with gastrointestinal tract bleeding.
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Question 1 of 1
1. Question
Week 513: Case 2
This middle-aged woman presented with gastrointestinal tract bleeding. Imaging revealed a large cystic mass in the tail of the pancreas. A distal pancreatectomy and partial gastrectomy were performed.images/REL_TWO_3A.jpg
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images/REL_TWO_3D.jpgCorrect
Answer: Mucinous cystic neoplasm (MCN) with high-grade dysplasia
Histology: The neoplasm is composed of mucin-producing columnar cells. The stroma has spindle-shaped “ovarian type stroma” appearance. The epithelium of the neoplasm merges onto the epithelium of the stomach.
Discussion: The diagnosis of a mucinous cystic neoplasm can be made in this case based on the combination of mucin-producing columnar epithelial cells and ovarian-type stroma. This large mucinous cystic neoplasm with high-grade dysplasia appears to have eroded into the stomach without actually invading into the tissue. This erosion is apparently caused by the “mass effect” of the tumor gradually wearing down the gastric wall. The most important thing to remember about mucinous cystic neoplasms is that invasive cancers can arise focally in these neoplasms. Extensive, if not complete, sampling for histology is therefore needed to rule out an invasive cancer in a mucinous cystic neoplasm.
Incorrect
Answer: Mucinous cystic neoplasm (MCN) with high-grade dysplasia
Histology: The neoplasm is composed of mucin-producing columnar cells. The stroma has spindle-shaped “ovarian type stroma” appearance. The epithelium of the neoplasm merges onto the epithelium of the stomach.
Discussion: The diagnosis of a mucinous cystic neoplasm can be made in this case based on the combination of mucin-producing columnar epithelial cells and ovarian-type stroma. This large mucinous cystic neoplasm with high-grade dysplasia appears to have eroded into the stomach without actually invading into the tissue. This erosion is apparently caused by the “mass effect” of the tumor gradually wearing down the gastric wall. The most important thing to remember about mucinous cystic neoplasms is that invasive cancers can arise focally in these neoplasms. Extensive, if not complete, sampling for histology is therefore needed to rule out an invasive cancer in a mucinous cystic neoplasm.
