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Presented by Ralph Hruban, M.D. and prepared by Whitney Green, M.D.
Case 2: This 50-some year old man presented with abdominal pain.
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Question 1 of 1
1. Question
Week 570: Case 2
This 50-some year old man presented with abdominal pain. A cystic mass was found in the head of the patient’s pancreasimages/Case2_2x.jpg
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images/Case2_highpowermitoses.jpgCorrect
Answer: Intraductal oncocytic papillary neoplasm with high-grade dysplasia
Histology: This intraductal neoplasm forms papillary projections into the lumen of the duct. The papillae are lined by large cells with voluminous eosinophilic cytoplasm. The nuclei are large and irregular, and several have a high nuclear to cytoplasmic ratio.
Discussion: Intraductal oncocytic papillary neoplasms (IOPNs) of the pancreas are distinctive tumors sometimes classified under the “intraductal papillary mucinous neoplasm” umbrella. IOPNs, as beautifully illustrated in this case, are lined by large cells with abundant eosinophilic cytoplasm. The oncocytic appearance is imparted by the presence of numerous mitochondria. Immunohistochemically, most IOPNs express CEA and MUC1, and scattered goblet cells in these neoplasms will express MUC5AC and MUC2. The presence or absence of an associated invasive component will drive prognosis and these neoplasms therefore need to be thoroughly and carefully examined.
Incorrect
Answer: Intraductal oncocytic papillary neoplasm with high-grade dysplasia
Histology: This intraductal neoplasm forms papillary projections into the lumen of the duct. The papillae are lined by large cells with voluminous eosinophilic cytoplasm. The nuclei are large and irregular, and several have a high nuclear to cytoplasmic ratio.
Discussion: Intraductal oncocytic papillary neoplasms (IOPNs) of the pancreas are distinctive tumors sometimes classified under the “intraductal papillary mucinous neoplasm” umbrella. IOPNs, as beautifully illustrated in this case, are lined by large cells with abundant eosinophilic cytoplasm. The oncocytic appearance is imparted by the presence of numerous mitochondria. Immunohistochemically, most IOPNs express CEA and MUC1, and scattered goblet cells in these neoplasms will express MUC5AC and MUC2. The presence or absence of an associated invasive component will drive prognosis and these neoplasms therefore need to be thoroughly and carefully examined.
