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Presented by Ralph Hruban, M.D. and prepared by Greg Seidel, M.D.
Case 4: This 75 year old man with a long-standing history of abdominal pain was found to have a cystic mass in the pancreas.
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1. Question
Week 116: Case 4
This 75 year old man with a long-standing history of abdominal pain was found to have a cystic mass in the pancreas./images/1216024a.jpg
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/images/1216024d.jpgCorrect
Answer: Intraductal Oncocytic Papillary Neoplasm (IOPN)
Histology: This cystic neoplasm communicates with the pancreatic ducts and is lined by papillary epithelium. The neoplastic epithelium is granular and eosinophilic.
Discussion: Intraductal oncocytic papillary neoplasms (IOPN) are rare cystic neoplasms of the pancreas that involve the larger ducts and show prominent oncocytic differentiation. IOPNs were described by Adsay et al. in 1996 (Am J Surg Pathol 1996;20:980-984). In their report, Adsay et al. reported 11 IOPNs with variably complex papillae lined by a stratified oncocytic epithelium. Two were associated with an invasive cancer. Recently, Patel et al. analyzed an IOPN at the molecular level and they were not able to demonstrate mutations in K-ras, DPC4 or p53.
Incorrect
Answer: Intraductal Oncocytic Papillary Neoplasm (IOPN)
Histology: This cystic neoplasm communicates with the pancreatic ducts and is lined by papillary epithelium. The neoplastic epithelium is granular and eosinophilic.
Discussion: Intraductal oncocytic papillary neoplasms (IOPN) are rare cystic neoplasms of the pancreas that involve the larger ducts and show prominent oncocytic differentiation. IOPNs were described by Adsay et al. in 1996 (Am J Surg Pathol 1996;20:980-984). In their report, Adsay et al. reported 11 IOPNs with variably complex papillae lined by a stratified oncocytic epithelium. Two were associated with an invasive cancer. Recently, Patel et al. analyzed an IOPN at the molecular level and they were not able to demonstrate mutations in K-ras, DPC4 or p53.
