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Presented by Ralph Hruban, M.D. and prepared by Carla Ellis, M.D.
Case 1: This 50 some year old woman was found to have a large peripancreatic mass.
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Question 1 of 1
1. Question
Week 439: Case 1
This 50 some year old woman was found to have a large peripancreatic mass. The mass was drained, but persisted in size. It was therefore surgically resected.images/1Alex/06142010case1image1.jpg
images/1Alex/06142010case1image2.jpg
images/1Alex/06142010case1image3.jpgCorrect
Answer: Mucinous cystic neoplasm with high-grade dysplasia
Histology: This neoplasm is composed of columnar mucin-producing cells with both significant architectural and significant cytologic atypia. In addition, the stroma is dense.
Discussion: Mucinous cystic neoplasms of the pancreas, as illustrated by this case, are composed of of columnar mucin-producing cells. In addition, by definition, the lesions have a distinctive “ovarian-type” stroma. This stroma will typically express PR and ER. The mucinous epithelium can have significant dysplasia, and up to one-third of the cases are associated with an invasive carcinoma.
The dysplasia, and even the invasive carcinoma, can be very focal. Extensive, if not even complete sampling of these neoplasms is therefore indicated. Although no invasive carcinoma was found in this case, the fact that it was drained before it was resected suggests that this patient should be carefully followed.
Incorrect
Answer: Mucinous cystic neoplasm with high-grade dysplasia
Histology: This neoplasm is composed of columnar mucin-producing cells with both significant architectural and significant cytologic atypia. In addition, the stroma is dense.
Discussion: Mucinous cystic neoplasms of the pancreas, as illustrated by this case, are composed of of columnar mucin-producing cells. In addition, by definition, the lesions have a distinctive “ovarian-type” stroma. This stroma will typically express PR and ER. The mucinous epithelium can have significant dysplasia, and up to one-third of the cases are associated with an invasive carcinoma.
The dysplasia, and even the invasive carcinoma, can be very focal. Extensive, if not even complete sampling of these neoplasms is therefore indicated. Although no invasive carcinoma was found in this case, the fact that it was drained before it was resected suggests that this patient should be carefully followed.
