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Presented by Ralph Hruban, M.D. and prepared by Carla Ellis, M.D.
Case 5: This patient presented with vague abdominal pain.
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1. Question
Week 439: Case 5
This patient presented with vague abdominal pain. A CT was obtained revealing a mass in the tail of the pancreas. A distal pancreatectomy was performed.images/1Alex/06142010case5image1.jpg
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images/1Alex/06142010case5image5.jpgCorrect
Answer: Well-differentiated endocrine neoplasm
Histology: This well-differentiated neoplasm is composed of nests and trabeculae of uniform cells. The nuclei have a “salt-and-pepper” appearance, although some do have appreciable nucleoli. Ducts without atypia are admixed amongst the neoplastic cells.
Discussion: This well-differentiated endocrine neoplasm (islet cell tumor), has trapped some non-neoplastic ducts. This finding can mimic a mixed Ductal-adenocarcinoma/well-differentiated adenocarcinoma until one realizes that the ducts are completely bland.
The old term “ductuloinsular carcinoma” is confusing and should not be used as it incorrectly suggests that the glands are neoplastic. Remember to comment on the proliferation rate when signing out well-differentiated endocrine neoplasm. In this case, the Ki-67 labeling index was 4%, making this a grade 2 lesion.
Incorrect
Answer: Well-differentiated endocrine neoplasm
Histology: This well-differentiated neoplasm is composed of nests and trabeculae of uniform cells. The nuclei have a “salt-and-pepper” appearance, although some do have appreciable nucleoli. Ducts without atypia are admixed amongst the neoplastic cells.
Discussion: This well-differentiated endocrine neoplasm (islet cell tumor), has trapped some non-neoplastic ducts. This finding can mimic a mixed Ductal-adenocarcinoma/well-differentiated adenocarcinoma until one realizes that the ducts are completely bland.
The old term “ductuloinsular carcinoma” is confusing and should not be used as it incorrectly suggests that the glands are neoplastic. Remember to comment on the proliferation rate when signing out well-differentiated endocrine neoplasm. In this case, the Ki-67 labeling index was 4%, making this a grade 2 lesion.
