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Presented by Ralph Hruban, M.D. and prepared by Orin Buetens, M.D.
Case 2: This 55 year-old woman presented with abdominal pain.
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Question 1 of 1
1. Question
Week 39: Case 2
This 55 year-old woman presented with abdominal pain. Imaging revealed a 5 cm mass in the pancreas. The mass was resected./images/1963a.jpg
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Answer: Acinar cell carcinoma
Histology: The neoplastic cells in this neoplasm primarily grow in sheets, however, focal acinar formation is seen. Immunohistochemical labeling revealed that the neoplastic cells express trypsin and lipase, while a stain for chromogranin was negative. Electron microscopy revealed numerous zymogen (200-700nm) granules. These are all diagnostic features of an acincar cell carcinoma
Discussion: Clinically, 15% of acincar cell carcinomas are associated with the syndrome of metastatic fat necrosis (fat necrosis, eosinophilia and arthritis). These are fully malignant neoplasms with an average survival of 22 months if they are resected. Tumor size appears to be a prognostic indicator, with those >10 cm doing worse.
Incorrect
Answer: Acinar cell carcinoma
Histology: The neoplastic cells in this neoplasm primarily grow in sheets, however, focal acinar formation is seen. Immunohistochemical labeling revealed that the neoplastic cells express trypsin and lipase, while a stain for chromogranin was negative. Electron microscopy revealed numerous zymogen (200-700nm) granules. These are all diagnostic features of an acincar cell carcinoma
Discussion: Clinically, 15% of acincar cell carcinomas are associated with the syndrome of metastatic fat necrosis (fat necrosis, eosinophilia and arthritis). These are fully malignant neoplasms with an average survival of 22 months if they are resected. Tumor size appears to be a prognostic indicator, with those >10 cm doing worse.
