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Presented by Ralph Hruban, M.D. and prepared by Joseph J. Maleszewski, M.D.
Case 6: This elderly patient presented with jaundice.
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1. Question
Week 378: Case 6
This elderly patient presented with jaundice. CT scanning revealed a mass in the pancreas.images/jjm011209/case6a.jpg
images/jjm011209/case6b.jpg
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images/jjm011209/case6d.jpg
images/jjm011209/case6e.jpgCorrect
Answer: Undifferentiated carcinoma
Histology: This neoplasm has two components. The first is a gland-forming adenocarcinoma. The second is a high-grade spindle cell neoplasm. Immunolabeling for e-cadherin shows intact expression in the glandular component and almost complete loss of e-cadherin expression in the spindle cell component.
Discussion: Undifferentiated carcinomas of the pancreas are among the most lethal of all of the carcinomas. As in this case, they sometimes arise in association with a better differentiated adenocarcinoma. When they do, the lower grade component provides a clue to their epithelial nature. The undifferentiated component often at least focally labels with antibodies to cytokeratin. Immunolabeling for e-cadherin, as in this case, often shows dramatic loss of e-cadherin expression in the undifferentiated cells.
Reference(s):
– Absence of E-cadherin expression distinguishes noncohesive from cohesive pancreatic cancer.Winter JM, Ting AH, Vilardell F, Gallmeier E, Baylin SB, Hruban RH, Kern SE, Iacobuzio-Donahue CA. Clin Cancer Res. 2008 Jan 15;14(2):412-8.Incorrect
Answer: Undifferentiated carcinoma
Histology: This neoplasm has two components. The first is a gland-forming adenocarcinoma. The second is a high-grade spindle cell neoplasm. Immunolabeling for e-cadherin shows intact expression in the glandular component and almost complete loss of e-cadherin expression in the spindle cell component.
Discussion: Undifferentiated carcinomas of the pancreas are among the most lethal of all of the carcinomas. As in this case, they sometimes arise in association with a better differentiated adenocarcinoma. When they do, the lower grade component provides a clue to their epithelial nature. The undifferentiated component often at least focally labels with antibodies to cytokeratin. Immunolabeling for e-cadherin, as in this case, often shows dramatic loss of e-cadherin expression in the undifferentiated cells.
Reference(s):
– Absence of E-cadherin expression distinguishes noncohesive from cohesive pancreatic cancer.Winter JM, Ting AH, Vilardell F, Gallmeier E, Baylin SB, Hruban RH, Kern SE, Iacobuzio-Donahue CA. Clin Cancer Res. 2008 Jan 15;14(2):412-8.
