Difference between revisions of "Cytologically Yours: Unknowns: 201401: Case 3"

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===Resident Questions===
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* <spoiler text="Diagnosis?">
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* Chronic pancreatits
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** Occurs in the 4th and 5th decades
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** Clinically presents as chronic recurrent abdominal pain
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** Triad steatorrhea, diabetes mellitus, and weight loss
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** Can present as a solid mass in the head of the pancreas
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** Radiologically can appear as an ill defined lobulated mass and the periphery of the lesion can look irregular
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** Strictures of the biliary or pancreatic ducts occurs as well as calcification
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</spoiler>
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* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">
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* Variable cellularity depending on the fibrosis in the specimen, however usually low cellularity
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* Smears are polymorphous (ductal cells, acinar cells, macrophages, inflammatory cells, fibrosis, debris, calcification, fat necrosis)
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* Hyperplastic and atypical ductal cells can be present, and can make it difficult to distinguish from adenocarcinoma.
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* Although markedly atypical cells may be present there will not be many and there will be no single atypical cells
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* Reactive cells will not have anisonucleosis and will not have nuclear irregularity
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* Ductal cells out number acinar cells (acinar atrophy)
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</spoiler>
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* <spoiler text="Differential diagnosis?"> 
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* Adenocarcinoma
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** Occurs later (6th and 7th decades)
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** Irregular nuclear contours, macronuclei, anisonucleosis
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** Positive staining for p53 and CDx-2
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** Negative staining for SMAD4
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* The presence of mitotic figures does not support the diagnosis of carcinoma. Mitotic figures can be seen in chronic pancreatitis.
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* Pancreatic cancer is often surrounded by a zone of pancreatitis, therefore pancreatits does not exclude malignancy nor does inflammation
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</spoiler>

Revision as of 12:28, 16 January 2014

Cytology

Resident Questions