Difference between revisions of "Cytologically Yours: Unknowns: 201401: Case 4"

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==Clinical History==
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74 year old male with a pancreatic 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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* Lymphoma
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** Occurs in elderly
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** Diffuse large B cell lymphoma is the most common
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** Presentation includes abdominal pain and jaundice due to bile duct obstruction
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** Pancreatic primary lymphoma accounts for less than 0.5% of all pancreatic malignancies and 1% of extranodal lymphomas
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** Secondary involvement of the pancreas by lymphoma has been reported to occur in 5-30% of all lymphomas.
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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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* Cellular specimen
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* Monotonous population of cells that are discohesive
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* Look for lymphoglandular bodies in the background
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* Cells will have high N/C ratios with round nuclei
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* Mitosis
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* Karryorrhexis
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* Lack nuclear molding
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* Rare tissue fragments
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</spoiler>
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* <spoiler text="Differential diagnosis?">__NOGLOSSARY__
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* Pancreatic neuroendocrine tumor
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** Uniform, small/medium sized, round, plasmacytoid cells
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** Cells in groups
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** Scant cytoplasm
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** Salt and pepper chromatin
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** Positive CD56, Synaptophysin, Chromogranin
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* Pancreatic duct adenocarcinoma (small cell pattern)
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** Generally cellular
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** Groups and single small/medium cells
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** Irregular nuclear membranes and variable cytoplasm (scant/moderate, vacuolated/dense)
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** Positive CEA, Cytokeratin, EMA
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* Lymphoepithelial cyst
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** Rare benign cystic lesion with lymphocytes
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** Most occur in male patients who are in the 5th decade
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** Unilocular or multilocular lined by squamous epithelium and have numerous lymphocytes
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** Cytology will have many lymphocytes and squamous cells
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** Not associated with immunosuppression
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* Flow cytometry is helpful when lymphoma is suspected
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</spoiler>
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<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the Additional Images.</div>
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==Additional Images==
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<gallery heights="500px" widths="500px">
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CytologicallyYoursUnknowns201401-04-07.jpg
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</gallery>
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{{Cytologically Yours}}
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[[Category:Unknowns]]

Latest revision as of 14:10, 16 January 2014

Contents

Clinical History

74 year old male with a pancreatic mass.

Cytology

Resident Questions

Click here to toggle the Additional Images.

Additional Images