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Presented by Dr. Pedram Argani and prepared by Dr. Jennifer Bynum
Case 1: This is an 80 year old female with a pancreatic mass
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Question 1 of 1
1. Question
Week (623): Case 1
This is an 80 year old female with a pancreatic mass.
Correct
Answer: Sarcomatoid carcinoma
Histology: This is a high grade malignant neoplasm with multiple morphologies. Some portions of the neoplasm are composed of malignant glands, consistent with the “large-gland” pattern of primary pancreatic adenocarcinoma. This pattern can mimic an intraductal papillary mucinous neoplasm. However, the majority of the neoplasm is sarcomatoid, and consists of malignant anaplastic and spindle cells which focally demonstrate osteoid formation (osteosarcomatous differentiation). Scattered within these anaplastic cells are bland, osteoclastic-like giant cells. The combination of these two morphologies is diagnostic of a sarcomatoid adenocarcinoma, clinically arising in the pancreas.
Discussion: Pancreatic adenocarcinoma may be associated with a highly cellular stroma which can raise the differential diagnosis of sarcomatoid carcinoma. However, this cellular stroma should not demonstrate the anaplasia and mitotic activity of a sarcomatoid carcinoma. Primary sarcomas of this organ are extremely rare, and the diagnosis of sarcomatoid carcinoma is much more likely. The additional malignant glandular component in this case establishes the diagnosis of sarcomatoid carcinoma. Mucinous cystic neoplasms are typically associated with ovarian type stroma, and may be associated with sarcomatoid change. The current lesion lacks the ovarian stroma and predominantly cystic appearance of the latter neoplasm.
Incorrect
Answer: Sarcomatoid carcinoma
Histology: This is a high grade malignant neoplasm with multiple morphologies. Some portions of the neoplasm are composed of malignant glands, consistent with the “large-gland” pattern of primary pancreatic adenocarcinoma. This pattern can mimic an intraductal papillary mucinous neoplasm. However, the majority of the neoplasm is sarcomatoid, and consists of malignant anaplastic and spindle cells which focally demonstrate osteoid formation (osteosarcomatous differentiation). Scattered within these anaplastic cells are bland, osteoclastic-like giant cells. The combination of these two morphologies is diagnostic of a sarcomatoid adenocarcinoma, clinically arising in the pancreas.
Discussion: Pancreatic adenocarcinoma may be associated with a highly cellular stroma which can raise the differential diagnosis of sarcomatoid carcinoma. However, this cellular stroma should not demonstrate the anaplasia and mitotic activity of a sarcomatoid carcinoma. Primary sarcomas of this organ are extremely rare, and the diagnosis of sarcomatoid carcinoma is much more likely. The additional malignant glandular component in this case establishes the diagnosis of sarcomatoid carcinoma. Mucinous cystic neoplasms are typically associated with ovarian type stroma, and may be associated with sarcomatoid change. The current lesion lacks the ovarian stroma and predominantly cystic appearance of the latter neoplasm.
