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Presented by Ralph Hruban, M.D. and prepared by Doreen Nguyen, M.D.
Case 1: This 25-year-old woman was incidentally found to have a 2cm enhancing, mostly solid, mass in the tail of her pancreas.
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1. Question
Week 561: Case 1
This 25-year-old woman was incidentally found to have a 2cm enhancing, mostly solid, mass in the tail of her pancreas. A distal pancreatectomy was performed.
Correct
Answer: Solid-pseudopapillary neoplasm
Histology: This is a touch preparation made from the cut surface of the tumor at the time of intraoperative frozen section consultation. Note the thin delicate branching blood vessels, and the poorly cohesive cells.
Discussion: Touch preparations performed at the time of intraoperative consultation can be very useful in the evaluation of mass lesions of the pancreas. Thin delicate branching blood vessels and poorly cohesive uniform cells (as seen here) are highly suggestive of a solid-pseudopapillary neoplasm. Well-differentiated pancreatic neuroendocrine tumors will be composed of more cohesive cells, and, although richly vascular, the vessels are not so thin nor do they branch so much.
Incorrect
Answer: Solid-pseudopapillary neoplasm
Histology: This is a touch preparation made from the cut surface of the tumor at the time of intraoperative frozen section consultation. Note the thin delicate branching blood vessels, and the poorly cohesive cells.
Discussion: Touch preparations performed at the time of intraoperative consultation can be very useful in the evaluation of mass lesions of the pancreas. Thin delicate branching blood vessels and poorly cohesive uniform cells (as seen here) are highly suggestive of a solid-pseudopapillary neoplasm. Well-differentiated pancreatic neuroendocrine tumors will be composed of more cohesive cells, and, although richly vascular, the vessels are not so thin nor do they branch so much.
