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Presented by Ralph Hruban, M.D. and prepared by Matthew Karafin, M.D.
Case 3: This lesion arose in the head of the pancreas and was associated with dilatation of the main pancreatic duct.
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Question 1 of 1
1. Question
Week 503: Case 3
This lesion arose in the head of the pancreas and was associated with dilatation of the main pancreatic duct.images/1alex/103111case3image1.jpg
images/1alex/103111case3image3.jpg
images/1alex/103111case3image2.jpgCorrect
Answer: Intraductal papillary mucinous neoplasm with high-grade dysplasia
Histology: The main pancreatic duct is lined by papillary mucin-producing epithelium with high-grade dysplasia (image 1,2). The stroma is collagenous (not the ovarian stroma of a mucinous cystic neoplasm). Several pools of mucin are present in the stroma, but these are acellular (image 3).
Discussion: Intraductal papillary mucinous neoplasms (IPMNs), as seen here, are mucin-producing epithelial neoplasms that involve the larger pancreatic ducts. IPMNs lack the ovarian stroma of mucinous cystic neoplasms. Intestinal type IPMNs can be associated with an invasive colloid carcinoma. The challenge is to distinguish mucin “extruded” from a distended IPMN from a truly invasive colloid carcinoma. The presence of epithelial cells floating in the stromal mucin establish an invasive colloid carcinoma (not present in this case).
Incorrect
Answer: Intraductal papillary mucinous neoplasm with high-grade dysplasia
Histology: The main pancreatic duct is lined by papillary mucin-producing epithelium with high-grade dysplasia (image 1,2). The stroma is collagenous (not the ovarian stroma of a mucinous cystic neoplasm). Several pools of mucin are present in the stroma, but these are acellular (image 3).
Discussion: Intraductal papillary mucinous neoplasms (IPMNs), as seen here, are mucin-producing epithelial neoplasms that involve the larger pancreatic ducts. IPMNs lack the ovarian stroma of mucinous cystic neoplasms. Intestinal type IPMNs can be associated with an invasive colloid carcinoma. The challenge is to distinguish mucin “extruded” from a distended IPMN from a truly invasive colloid carcinoma. The presence of epithelial cells floating in the stromal mucin establish an invasive colloid carcinoma (not present in this case).
