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Presented by Ralph Hruban, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 6: This woman in her 40’s developed non-specific epigastric fullness.
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1. Question
Week 321: Case 6
This woman in her 40’s developed non-specific epigastric fullness.images/6A_08_13_07.jpg
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images/6E_08_13_07.jpgCorrect
Answer: Mucinous cystic neoplasm
Histology: This cystic neoplasm in the pancreas is composed of large (several cm) cysts. The cysts are lined by tall columnar mucin-producing epithelium without atypia. The stroma contains densely packed spindle-shaped cells.
Discussion: Mucinous cystic neoplasms of the pancreas are more common in women than in men, and they arise in the tail of the pancreas more often than they do in the head. The cysts are usually large, and can contain thick tenacious mucin, thin watery fluid, or blood. By light microscopy the cysts are lined by a columnar mucin-producing epithelium. The epithelium can show varying degrees of dysplasia, and this dysplasia is graded as low-grade, moderate or high-grade. In addition, mucinous cystic neoplasms have a characteristic ovarian-type of stroma. This stroma can be a clue to the diagnosis in cases in which the epithelium has been denuded. The presence or absence of an invasive carcinoma is the most important prognosticator for patients with a mucinous cystic neoplasm.
Incorrect
Answer: Mucinous cystic neoplasm
Histology: This cystic neoplasm in the pancreas is composed of large (several cm) cysts. The cysts are lined by tall columnar mucin-producing epithelium without atypia. The stroma contains densely packed spindle-shaped cells.
Discussion: Mucinous cystic neoplasms of the pancreas are more common in women than in men, and they arise in the tail of the pancreas more often than they do in the head. The cysts are usually large, and can contain thick tenacious mucin, thin watery fluid, or blood. By light microscopy the cysts are lined by a columnar mucin-producing epithelium. The epithelium can show varying degrees of dysplasia, and this dysplasia is graded as low-grade, moderate or high-grade. In addition, mucinous cystic neoplasms have a characteristic ovarian-type of stroma. This stroma can be a clue to the diagnosis in cases in which the epithelium has been denuded. The presence or absence of an invasive carcinoma is the most important prognosticator for patients with a mucinous cystic neoplasm.
