View source for Cytologically Yours: Unknowns: 201401: Case 6

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

==Cytology==
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===Resident Questions===
* <spoiler text="Diagnosis?">__NOGLOSSARY__
* Pseudocyst
** Most common cystic lesion
** Etiology is diverse (acute pancreatitis, recurrent chronic pancreatitis, trauma, chronic alcohol abuse)
** Clinically patients present with jaundice, pain, nausea, vomiting, weight loss
** Pathogenesis
*** leakage of pancreatic enzymes into parenchyma 
*** necrosis and chemical peritonitis
*** inflammatory response and pancreatic secretion accumulation occurs and fibrous tissue walls off irritants which causes cyst formation
** Localized collection of amylase rich pancreatic secretions, necrotic debris and blood
** Most occur in the tail of the pancreas
** Usually solitary and unilocular
** Lack a true epithelial lining
</spoiler>
* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">__NOGLOSSARY__
* Variable acute and chronic inflammation
* Histiocytes
* Giant cells
* Necrotic debris
* Granulation tissue may be present
* No epithelium with atypia
</spoiler>
* <spoiler text="Differential diagnosis?">  
* Ductal adenocarcinoma with cystic degeneration
** Atypia in the epithelium
** Pleomorphic nuclei, cytoplasm variable (vacuolated to dense) 
** Cellular inflammatory background
** Positive CEA and cytokeratin 
* Any neoplasm will have epithelial groups and single cells with atypia
* Big diagnostic problem is the atypia that can be seen in the granulation tissue
</spoiler>

{{Cytologically Yours}}

[[Category:Unknowns]]