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Presented by Ralph Hruban, M.D. and prepared by Jon Davison, M.D.
Case 3: This middle aged patient was found to have a large solid pancreatic mass.
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Week 188: Case 3
This middle aged patient was found to have a large solid pancreatic mass.images/JMD 6-14-04 SPWC/Case 3/a.jpg
images/JMD 6-14-04 SPWC/Case 3/b.jpg
images/JMD 6-14-04 SPWC/Case 3/c.jpg
images/JMD 6-14-04 SPWC/Case 3/d.jpg
images/JMD 6-14-04 SPWC/Case 3/e.jpgCorrect
Answer: Solitary fibrous tumor
Histology: This spindle cell neoplasm closely abuts the pancreas and is relatively well-demarcated. The neoplasm shows less cellular areas with prominent collagenization and areas of increased cellularity. The neoplastic cells are cytologically bland and spindled with areas demonatrating a haphazard “patternless” pattern of growth. Other areas show a more pericytic pattern. The less cellular areas are admixed with keloid-like collagen. The vasculature shows an hemangiopericytic pattern with staghorn branching vessels.
Discussion: Solitary fibrous tumors were first described in the pleura, but have since been recognized throughout the body. By light microscopy they are composed of relatively uniform spindle shaped cells often arranged haphazardly. The cells are admixed with keloid-like collagen, producing cellular and less cellular areas within the tumor. Hemangiopericytoma-like vessels are one of the most characteristic features of this neoplasm. When suspected, immunohistochemical labeling can help confirm the diagnosis. These neoplasms are CD34, bcl-2, factor XIIIa, and vimentin positive.
Incorrect
Answer: Solitary fibrous tumor
Histology: This spindle cell neoplasm closely abuts the pancreas and is relatively well-demarcated. The neoplasm shows less cellular areas with prominent collagenization and areas of increased cellularity. The neoplastic cells are cytologically bland and spindled with areas demonatrating a haphazard “patternless” pattern of growth. Other areas show a more pericytic pattern. The less cellular areas are admixed with keloid-like collagen. The vasculature shows an hemangiopericytic pattern with staghorn branching vessels.
Discussion: Solitary fibrous tumors were first described in the pleura, but have since been recognized throughout the body. By light microscopy they are composed of relatively uniform spindle shaped cells often arranged haphazardly. The cells are admixed with keloid-like collagen, producing cellular and less cellular areas within the tumor. Hemangiopericytoma-like vessels are one of the most characteristic features of this neoplasm. When suspected, immunohistochemical labeling can help confirm the diagnosis. These neoplasms are CD34, bcl-2, factor XIIIa, and vimentin positive.
