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Presented by Ralph Hruban, M.D. and prepared by Robert E LeBlanc, M.D.
Case 3: This middle-aged woman was imaged for another indication and found to have a calcified, slightly cystic mass in the tail of her pancreas.
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Week 524: Case 3
This middle-aged woman was imaged for another indication and found to have a calcified, slightly cystic mass in the tail of her pancreas. A distal pancreatectomy was performed.images/RHH3 01.jpg
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images/RHH3 04.jpgCorrect
Answer: Mucinous cystic neoplasm with low-grade and heterotopic bone formation
Histology: Although much of the lesion is composed of mature bone, some of which contains islets of Langerhans (!), foci contain mucin-producing epithelium with ovarian-type stroma.
Discussion: It is not unusual to find focal heterotopic bone formation in a mucinous cystic neoplasm of the pancreas, but I have never seen such extensive bone formation before. This bone formation speaks to the indolent nature of most mucinous cystic neoplasms. In this case one can even appreciate islets of Langerhans in the bone. Importantly, this mucinous cystic neoplasm was completely resected and examined histologically in its entirety. In the absence of invasion, this patient should be cured.
Incorrect
Answer: Mucinous cystic neoplasm with low-grade and heterotopic bone formation
Histology: Although much of the lesion is composed of mature bone, some of which contains islets of Langerhans (!), foci contain mucin-producing epithelium with ovarian-type stroma.
Discussion: It is not unusual to find focal heterotopic bone formation in a mucinous cystic neoplasm of the pancreas, but I have never seen such extensive bone formation before. This bone formation speaks to the indolent nature of most mucinous cystic neoplasms. In this case one can even appreciate islets of Langerhans in the bone. Importantly, this mucinous cystic neoplasm was completely resected and examined histologically in its entirety. In the absence of invasion, this patient should be cured.
