View source for Cytologically Yours: Unknowns: 201401: Case 4

==Clinical History==
74 year old male with a pancreatic mass.

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

[[Category:Unknowns]]