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Presented by Ralph Hruban, M.D. and prepared by Andrea Subhawong, M.D.
Case 6: This 60-year-old man complained of years of intermittent abdominal pain and new onset diabetes mellitus.
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Question 1 of 1
1. Question
Week 399: Case 6
This 60-year-old man complained of years of intermittent abdominal pain and new onset diabetes mellitus. A Whipple was performed. This is a frozen section of the pancreatic parenchymal margin.images/7.13.09.06a.jpg
images/7.13.09.06b.jpg
images/7.13.09.06c.jpg
images/7.13.09.06d.jpg
images/7.13.09.06e.jpgCorrect
Answer: Intraductal papillary mucinous neoplasm and invasive colloid carcinoma
Histology: This papillary neoplasia shows a prominent intraductal pattern of growth. The papillae are long and abundant mucin production is evident. In addition, pools of mucin are present in the stroma. Some of these pools are associated with free-floating and strips of neoplastic epithelial cells.
Discussion: Almost all colloid carcinomas (mucinous noncystic carcinomas) of the pancreas arise in association with an intraductal papillary mucinous neoplasm. Colloid carcinomas need to be distinguished from the non-neoplastic extrusion of mucin. Two features help establish the diagnosis of a colloid cancer- 1)free floating neoplastic cells in the stromal mucin and 2)epithelium where it doesn’t belong (i.e. around a nerve).
Incorrect
Answer: Intraductal papillary mucinous neoplasm and invasive colloid carcinoma
Histology: This papillary neoplasia shows a prominent intraductal pattern of growth. The papillae are long and abundant mucin production is evident. In addition, pools of mucin are present in the stroma. Some of these pools are associated with free-floating and strips of neoplastic epithelial cells.
Discussion: Almost all colloid carcinomas (mucinous noncystic carcinomas) of the pancreas arise in association with an intraductal papillary mucinous neoplasm. Colloid carcinomas need to be distinguished from the non-neoplastic extrusion of mucin. Two features help establish the diagnosis of a colloid cancer- 1)free floating neoplastic cells in the stromal mucin and 2)epithelium where it doesn’t belong (i.e. around a nerve).
