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Presented by Ralph Hruban, M.D. and prepared by Jeffrey Seibel, M.D. Ph.D.
Case 3: This 81 year old man with vague abdominal fullness was found to have a cystic mass in the head of his pancreas.
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Week 77: Case 3
This 81 year old man with vague abdominal fullness was found to have a cystic mass in the head of his pancreas./images/021002case3a.jpg
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/images/021002case3d.jpgCorrect
Answer: IPMN with associated anaplastic carcinoma
Histology: This pancreatic neoplasm has two distinct components. The first is a large
papillary tumor composed of mucin producing columnar cells. The second is a much higher grade infiltrating neoplasm composed of large cells with bizarre nuclei.Discussion: The first component of this neoplasm is clearly an intraductal papillary mucinous neoplasm. It is not a mucinous cystadenocarcinoma because it lacks the ovarian-type stroma seen in mucinous cystadenocarcinoma and it would be very unusual for a mucinous cystic neoplasm to arise in a male. The second component of this neoplasm is an anaplastic carcinoma. The enlarged cells in this tumor are much more bizarre than one would see in an undifferentiated carcinoma with osteoclast-like giant cells. The origin of anaplastic carcinoma arising in association with better differentiated glandular neoplasms has long been debated, but recent molecular evidence establishes that the anaplastic carcinoma arises from the better differentiated component (i.e. they are not collison tumors).
Incorrect
Answer: IPMN with associated anaplastic carcinoma
Histology: This pancreatic neoplasm has two distinct components. The first is a large
papillary tumor composed of mucin producing columnar cells. The second is a much higher grade infiltrating neoplasm composed of large cells with bizarre nuclei.Discussion: The first component of this neoplasm is clearly an intraductal papillary mucinous neoplasm. It is not a mucinous cystadenocarcinoma because it lacks the ovarian-type stroma seen in mucinous cystadenocarcinoma and it would be very unusual for a mucinous cystic neoplasm to arise in a male. The second component of this neoplasm is an anaplastic carcinoma. The enlarged cells in this tumor are much more bizarre than one would see in an undifferentiated carcinoma with osteoclast-like giant cells. The origin of anaplastic carcinoma arising in association with better differentiated glandular neoplasms has long been debated, but recent molecular evidence establishes that the anaplastic carcinoma arises from the better differentiated component (i.e. they are not collison tumors).
