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Presented by Dr. Pedram Argani and prepared by Dr. Yembur Ahmad
This case talks about a 64 year old female with a peripancreatic nodule.
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1. Question
This is a 64 year old female with a peripancreatic nodule.
Diagnosis:
Correct
Answer: C
Histologic Description: This is a highly sclerotic lesion, containing nests and cords of epithelioid cells. These cells have fine nuclear chromatin that is dispersed in a neuroendocrine type pattern, and the cytoplasm is finely granular. While the cording pattern suggests an epithelial lesion, the lesion is negative for cytokeratins, demonstrates diffuse labeling for chromogranin and synaptophysin, and demonstrates nuclear labeling for GATA3. These features support the diagnosis of a sclerosing paraganglioma.
Differential Diagnosis: Metastatic lobular carcinoma is a significant concern when one encounters a cord like lesion is the abdominal cavity of a women. However, the lesion is cytokeratin negative, and was negative for estrogen receptors which excludes a low grade lobular carcinoma. The absence of labeling for cytokeratin excludes a well differentiated pancreatic endocrine neoplasm. The diffuse labeling for chromogranin and synaptophysin would argue against a gastrointestinal stromal tumor, as would the negativity for CD117.Incorrect
Answer: C
Histologic Description: This is a highly sclerotic lesion, containing nests and cords of epithelioid cells. These cells have fine nuclear chromatin that is dispersed in a neuroendocrine type pattern, and the cytoplasm is finely granular. While the cording pattern suggests an epithelial lesion, the lesion is negative for cytokeratins, demonstrates diffuse labeling for chromogranin and synaptophysin, and demonstrates nuclear labeling for GATA3. These features support the diagnosis of a sclerosing paraganglioma.
Differential Diagnosis: Metastatic lobular carcinoma is a significant concern when one encounters a cord like lesion is the abdominal cavity of a women. However, the lesion is cytokeratin negative, and was negative for estrogen receptors which excludes a low grade lobular carcinoma. The absence of labeling for cytokeratin excludes a well differentiated pancreatic endocrine neoplasm. The diffuse labeling for chromogranin and synaptophysin would argue against a gastrointestinal stromal tumor, as would the negativity for CD117.
