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Presented by Ralph Hruban, M.D. and prepared by Maryam Farinola M.D.
Case 4: This elderly man was found to have a 5 cm cystic mass in his pancreas.
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1. Question
Week 176: Case 4
This elderly man was found to have a 5 cm cystic mass in his pancreas.images/cystic NE neoplasm 1.jpg
images/cystic NE neoplasm 2.jpg
images/cystic NE neoplasm 3.jpg
images/cystic NE neoplasm 4.jpgCorrect
Answer: Pancreatic neuroendocrine neoplasm
Histology: This cystic neoplasm was filled with clear fluid. The cyst is lined by a layer of connective tissue. Within the wall of the cyst one can appreciate a well-differentiated endocrine neoplasm.
Discussion: Cystic degeneration occurs in pancreatic endocrine neoplasms (PEN). These cystic PENs can mimic other cystic tumors of the pancreas. In particular, cystic PENs need to be distinguished from the solid-pseudopapillary neoplasm (SPN). SPNs are composed of non-cohesive cells surrounding delicate blood vessels; and the cystic spaces are filled with hemorrhagic/necrotic material. Immunolabeling can help distinguish between these two entities. Cystic PENs will strongly label for chromogranin. By contrast, SPNs will express CD10 and will slow an abnormal nuclear pattern of labeling with antibodies to â-catenin.
Incorrect
Answer: Pancreatic neuroendocrine neoplasm
Histology: This cystic neoplasm was filled with clear fluid. The cyst is lined by a layer of connective tissue. Within the wall of the cyst one can appreciate a well-differentiated endocrine neoplasm.
Discussion: Cystic degeneration occurs in pancreatic endocrine neoplasms (PEN). These cystic PENs can mimic other cystic tumors of the pancreas. In particular, cystic PENs need to be distinguished from the solid-pseudopapillary neoplasm (SPN). SPNs are composed of non-cohesive cells surrounding delicate blood vessels; and the cystic spaces are filled with hemorrhagic/necrotic material. Immunolabeling can help distinguish between these two entities. Cystic PENs will strongly label for chromogranin. By contrast, SPNs will express CD10 and will slow an abnormal nuclear pattern of labeling with antibodies to â-catenin.
