Difference between revisions of "Cytologically Yours: Unknowns: 201401: Case 2"

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==Clinical History==
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52 year old female with a pancreatic head mass.
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==Cytology==
 
==Cytology==
 
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===Resident Questions===
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* <spoiler text="Diagnosis?">__NOGLOSSARY__
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* Pancreatic Endocrine Neoplasm
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** Include Islet cell tumor and pancreatic carcinoid tumors
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** Approximately 5% of pancreatic neoplasms
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** Most commonly seen in both male and female adults between 40-60 years old but can occur at any age
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** Small (1-5 cm) well circumscribed lesion may look cystic on imaging
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** Commonly seen in the tail of the pancreas
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** Can be part of Multiple Endocrine Neoplasia-1, von Hipple-Lindau disease, Neurofibromatosis type 1, Tuberous Sclerosis Complex
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</spoiler>
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* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">__NOGLOSSARY__
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* Cellular smear with singly dispersed uniform cells
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* Loosely cohesive or discohesive uniform cells
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* Cells are uniform, plasmacytoid with abundant finely granular cytoplasm
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* Background is clean
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* Occasional pleomorphism can be seen
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* Round/oval bland cells with salt and pepper chromatin
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</spoiler>
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* <spoiler text="Differential diagnosis?">__NOGLOSSARY__
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* Acinar cell carcinoma
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** Clusters, acinar groups and single cells with abundant granular cytoplasm and prominent nucleoli
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** Lack salt and pepper chromatin
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** Positive staining for trypsin, chymotrypsin and alpha-1-antichymotrypsin
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** Negative for neuroendocrine markers
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* Solid Pseudopapillary Neoplasm
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** May see hyaline globules and clear cytoplasmic vacuoles
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** Branching papillary clusters with distinct central fibrovascular cores, but this can be seen in PEN too
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** Positive for vimentin, CD10, beta catenin, neuron specific enolase, CD56
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** Negative for keratin markers
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* Plasmacytoma
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** Look for a perinuclear hof and clock face chromatin
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** Positive staining for CD138
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** Negative for neuroendocrine markers
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* Islet cell hyperplasia
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** Difficult/ impossible to distinguish from islet cell tumor by cytology alone
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* Melanoma
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** Can see melanin pigment in the cytoplasm but not always
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** Melanoma cytomorphology can be quite diverse
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** Positive for MART-1, HMB45, MITF
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** Negative for neuroendocrine markers
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</spoiler>
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*<spoiler text="What ancillary studies would you order?">
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* Neuroendocrine markers
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** CD56
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** Synaptophysin
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** Chromogranin
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* Cytokeratin
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* TTF-1
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* Markers specific to peptide production
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</spoiler>
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{{Cytologically Yours}}
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[[Category:Unknowns]]

Latest revision as of 14:04, 16 January 2014

Clinical History

52 year old female with a pancreatic head mass.

Cytology

Resident Questions