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Presented by Ralph Hruban, M.D. and prepared by Doreen Nguyen, M.D.
Case 2: This elderly man was found to have a pancreatic mass with several associated enlarged lymph nodes.
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Question 1 of 1
1. Question
Week 564: Case 2
This elderly man was found to have a pancreatic mass with several associated enlarged lymph nodes. The pancreas and nodes were resected.images/D Nguyen/9-3-13/case 2/4x_450 pixels.jpg
images/D Nguyen/9-3-13/case 2/4x_tumor_450 pixels.jpg
images/D Nguyen/9-3-13/case 2/4x_tumor2_450 pixels.jpg
images/D Nguyen/9-3-13/case 2/10x_tumor_450 pixels.jpg
images/D Nguyen/9-3-13/case 2/10x_lymph node_450 pixels.jpgCorrect
Answer: Medullary cancer of the pancreas
Histology: The lesion consists of an intense lymphocytic infiltrate with admixed larger pleomorphic cells. The latter label with antibodies to cytokeratin.
The lesion has “pushing” rather than infiltrative boarders.
Discussion: Medullary carcinoma of the pancreas is a rare epithelial neoplasm (carcinoma) characterized by poor differentiation, a syncytial growth pattern, pushing boarders and an intense lymphocytic infiltration. As is true for medullary carcinomas of the colon, some medullary cancers of the pancreas are microsatellite unstable, and some have been reported in patients with hereditary nonpolyposis colorectal cancer syndrome
Reference(s):
– Wilentz RE, Goggins M, Redston M, Marcus VA, Adsay NV, Sohn TA, Kadkol SS, Yeo CJ, Choti M, Zahurak M, Johnson K, Tascilar M, Offerhaus GJ, Hruban RH, Kern SE. Genetic, immunohistochemical, and clinical features of medullary carcinoma of the pancreas: A newly described and characterized entity. Am J Pathol. 2000 May;156(5):1641-51.Incorrect
Answer: Medullary cancer of the pancreas
Histology: The lesion consists of an intense lymphocytic infiltrate with admixed larger pleomorphic cells. The latter label with antibodies to cytokeratin.
The lesion has “pushing” rather than infiltrative boarders.
Discussion: Medullary carcinoma of the pancreas is a rare epithelial neoplasm (carcinoma) characterized by poor differentiation, a syncytial growth pattern, pushing boarders and an intense lymphocytic infiltration. As is true for medullary carcinomas of the colon, some medullary cancers of the pancreas are microsatellite unstable, and some have been reported in patients with hereditary nonpolyposis colorectal cancer syndrome
Reference(s):
– Wilentz RE, Goggins M, Redston M, Marcus VA, Adsay NV, Sohn TA, Kadkol SS, Yeo CJ, Choti M, Zahurak M, Johnson K, Tascilar M, Offerhaus GJ, Hruban RH, Kern SE. Genetic, immunohistochemical, and clinical features of medullary carcinoma of the pancreas: A newly described and characterized entity. Am J Pathol. 2000 May;156(5):1641-51.
