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Presented by Ralph Hruban, M.D. and prepared by Zarir E. Karanjawala, M.D., Ph.D.
Case 6: This adult patient was found to have a 6 cm mass in the pancreas.
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1. Question
Week 335: Case 6
This adult patient was found to have a 6 cm mass in the pancreas. The mass was resected./images/hruban121707_6a.jpg
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/images/hruban121707_6djpgCorrect
Answer: Well-differentiated pancreatic endocrine neoplasm
Histology: This neoplasm is composed of uniform gland-forming cells associated with a dense eosinophilic cytoplasm. The nuclei of the neoplastic cells are uniform, and have a “salt and pepper” chromatin pattern.
Discussion: Two features are highlighted in this well-differentiated pancreatic endocrine neoplasm. First, lumen formation, although unusual, can be seen in well-differentiated pancreatic endocrine neoplasms. The cells lining these lumina are otherwise indistinguishable from the cells of a more solid well-differentiated pancreatic endocrine neoplasm. This lumen formation has no particular prognostic significance and should not be confused with an adenocarcinoma component in which the nuclear features would be those of a carcinoma. The second feature highlighted by this case is the eosinophilic stroma that can be abundant in some well-differentiated pancreatic endocrine neoplasms. This should not be confused with the more cellular desmoplastic stroma associated with infiltrating ductal adenocarcinomas. In most instances the eosinophilic stroma is composed of collagen, but in some well-differentiated pancreatic endocrine neoplasms the material is amyloid.
Incorrect
Answer: Well-differentiated pancreatic endocrine neoplasm
Histology: This neoplasm is composed of uniform gland-forming cells associated with a dense eosinophilic cytoplasm. The nuclei of the neoplastic cells are uniform, and have a “salt and pepper” chromatin pattern.
Discussion: Two features are highlighted in this well-differentiated pancreatic endocrine neoplasm. First, lumen formation, although unusual, can be seen in well-differentiated pancreatic endocrine neoplasms. The cells lining these lumina are otherwise indistinguishable from the cells of a more solid well-differentiated pancreatic endocrine neoplasm. This lumen formation has no particular prognostic significance and should not be confused with an adenocarcinoma component in which the nuclear features would be those of a carcinoma. The second feature highlighted by this case is the eosinophilic stroma that can be abundant in some well-differentiated pancreatic endocrine neoplasms. This should not be confused with the more cellular desmoplastic stroma associated with infiltrating ductal adenocarcinomas. In most instances the eosinophilic stroma is composed of collagen, but in some well-differentiated pancreatic endocrine neoplasms the material is amyloid.
