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Presented by Risa Mann, M.D. and prepared by Bahram R. Oliai, M.D.
Case 6: 56-year-old male with a mass in the pancreatic head.
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1. Question
Week 88: Case 6
56-year-old male with a mass in the pancreatic head./images/2335a.jpg
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Answer: Microcystic cystadenoma (glycogen rich serous cystadenoma)
Histology: This patient was found to have a solitary cystic mass in the pancreas. Microscopically, the lesion is composed of many small cystic spaces that are lined by low or flat cuboidal cells that contain abundant glycogen. The cells have small bland appearing nuclei, lack cytologic atypia or significant mitotic activity. Mucin or papillary growth pattern is absent.
Discussion: This lesion has a very distinctive pattern that is usually composed of multiple small cystic spaces lined by small cuboidal cells with central nuclei. The fluid contained within the cyst has a low CEA level in contrast to mucinous neoplasms. The cells lining the cystic spaces are positive for EMA and low molecular weight keratin. The lack of cytologic atypia favors this being a benign lesion and the lack of mucin rules out the more common mucinous tumor of the pancreas. Tumors such as this may present with abdominal pain or discomfort. If the lesion is in the head of the pancreas these tumors may result in biliary or gastrointestinal obstruction. Some cases of this type of tumor may occur in the context of von Hippel-Lindau disease.
Incorrect
Answer: Microcystic cystadenoma (glycogen rich serous cystadenoma)
Histology: This patient was found to have a solitary cystic mass in the pancreas. Microscopically, the lesion is composed of many small cystic spaces that are lined by low or flat cuboidal cells that contain abundant glycogen. The cells have small bland appearing nuclei, lack cytologic atypia or significant mitotic activity. Mucin or papillary growth pattern is absent.
Discussion: This lesion has a very distinctive pattern that is usually composed of multiple small cystic spaces lined by small cuboidal cells with central nuclei. The fluid contained within the cyst has a low CEA level in contrast to mucinous neoplasms. The cells lining the cystic spaces are positive for EMA and low molecular weight keratin. The lack of cytologic atypia favors this being a benign lesion and the lack of mucin rules out the more common mucinous tumor of the pancreas. Tumors such as this may present with abdominal pain or discomfort. If the lesion is in the head of the pancreas these tumors may result in biliary or gastrointestinal obstruction. Some cases of this type of tumor may occur in the context of von Hippel-Lindau disease.
