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Presented by Ralph Hruban, M.D. and prepared by Doreen Nguyen, M.D.
Case 3: This patient underwent a Whipple procedure for biopsy-proven infiltrating ductal adenocarcinoma.
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1. Question
Week 562: Case 3
This patient underwent a Whipple procedure for biopsy-proven infiltrating ductal adenocarcinoma. In addition to the poorly defined ductal adenocarcinoma, a separate well-demarcated orange and tallow nodule was found in the resected specimen.images/D Nguyen/8-12-13/case 3/2x_450 pixels.jpg
images/D Nguyen/8-12-13/case 3/4x_450 pixels.jpg
images/D Nguyen/8-12-13/case 3/10x_450 pixels.jpg
images/D Nguyen/8-12-13/case 3/10x_plump_450 pixels.jpg
images/D Nguyen/8-12-13/case 3/20x_450 pixels.jpgCorrect
Answer: Metastatic renal cell carcinoma
Histology: This nodule was distinct from the adjacent infiltrating ductal adenocarcinoma. It is composed of optically clear cells with a rich vasculature. These cells have moderate pleomorphism.
Discussion: The lesion labeled with markers of renal differentiation including RCC and it was negative for neuroendocrine markers (synaptophysin etc).
Although the patient didn’t initially provide a clinical history of having had a renal cell carcinoma, review of the abdominal CT scans revealed the “congenital absence” of one of the kidneys. On further questioning the patient recalled having had a nephrectomy for renal cell carcinoma.
Although it is much more common for pancreatic cancer to metastasize to other organs, cancers of other organs can rarely spread to the pancreas. In addition to cancers of the immediately adjacent organs (duodenum etc), breast, lung, melanoma and renal cell carcinoma can all spread to the pancreas.
Reference(s):
– Ahmed S, Johnson PT, Hruban R, Fishman EK. Metastatic disease to the pancreas: pathologic spectrum and CT patterns. Abdom Imaging. 2013 Feb;38(1):144-53.Incorrect
Answer: Metastatic renal cell carcinoma
Histology: This nodule was distinct from the adjacent infiltrating ductal adenocarcinoma. It is composed of optically clear cells with a rich vasculature. These cells have moderate pleomorphism.
Discussion: The lesion labeled with markers of renal differentiation including RCC and it was negative for neuroendocrine markers (synaptophysin etc).
Although the patient didn’t initially provide a clinical history of having had a renal cell carcinoma, review of the abdominal CT scans revealed the “congenital absence” of one of the kidneys. On further questioning the patient recalled having had a nephrectomy for renal cell carcinoma.
Although it is much more common for pancreatic cancer to metastasize to other organs, cancers of other organs can rarely spread to the pancreas. In addition to cancers of the immediately adjacent organs (duodenum etc), breast, lung, melanoma and renal cell carcinoma can all spread to the pancreas.
Reference(s):
– Ahmed S, Johnson PT, Hruban R, Fishman EK. Metastatic disease to the pancreas: pathologic spectrum and CT patterns. Abdom Imaging. 2013 Feb;38(1):144-53.
