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Presented by Pedram Argani, M.D. and prepared by Whitney Green, M.D.
Case 1: This is a 65 year old male with a pancreatic mass involving bile duct.
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Question 1 of 1
1. Question
Week 578: Case 1
This is a 65 year old male with a pancreatic mass involving bile ductimages/Case4_PAimage1.jpg
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images/Case4_PAimage5.jpgCorrect
Answer: Malignant melanoma
Histology: This a high grade spindled and epithelioid malignant neoplasm that involves the pancreas and bile duct. The lesional cells have prominent nucleoli, which suggest acinic carcinoma or melanoma. The lesion demonstrates strong immunoreactivity for HMB45 and Melan A. On further questioning, the patient revealed a distant history of cutaneous malignant melanoma.
MITF
MELAN-A
SOX10
Discussion: Acinic cell carcinoma is suggested when one sees a solid stroma poor neoplasm in the pancreas with prominent nucleoli. However, the current lesion shows no evidence of epithelial differentiation, and lacks expression for cytokeratin. Medullary carcinoma of the pancreas morphologically resembles microsatellite unstable undifferentiated colorectal adenocarcinomas. These lesions like ductal adenocarcinomas would label for cytokeratin and not for melanocytic markers like the current case.
Incorrect
Answer: Malignant melanoma
Histology: This a high grade spindled and epithelioid malignant neoplasm that involves the pancreas and bile duct. The lesional cells have prominent nucleoli, which suggest acinic carcinoma or melanoma. The lesion demonstrates strong immunoreactivity for HMB45 and Melan A. On further questioning, the patient revealed a distant history of cutaneous malignant melanoma.
MITF
MELAN-A
SOX10
Discussion: Acinic cell carcinoma is suggested when one sees a solid stroma poor neoplasm in the pancreas with prominent nucleoli. However, the current lesion shows no evidence of epithelial differentiation, and lacks expression for cytokeratin. Medullary carcinoma of the pancreas morphologically resembles microsatellite unstable undifferentiated colorectal adenocarcinomas. These lesions like ductal adenocarcinomas would label for cytokeratin and not for melanocytic markers like the current case.
