Cytologically Yours: Unknowns: 201401: Case 3: Difference between revisions - Pathology Education Instructional Resource

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==Clinical History==

45 year old male with weight loss and jaundice.

==Cytology==

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CytologicallyYoursUnknowns201401-03-06.jpg

</gallery>

===Resident Questions===

* <spoiler text="Diagnosis?">__NOGLOSSARY__

* Chronic pancreatits

** Occurs in the 4th and 5th decades

** Clinically presents as chronic recurrent abdominal pain

** Triad steatorrhea, diabetes mellitus, and weight loss

** Can present as a solid mass in the head of the pancreas

** Radiologically can appear as an ill defined lobulated mass and the periphery of the lesion can look irregular

** Strictures of the biliary or pancreatic ducts occurs as well as calcification

</spoiler>

* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">__NOGLOSSARY__

* Variable cellularity depending on the fibrosis in the specimen, however usually low cellularity

* Smears are polymorphous (ductal cells, acinar cells, macrophages, inflammatory cells, fibrosis, debris, calcification, fat necrosis)

* Hyperplastic and atypical ductal cells can be present, and can make it difficult to distinguish from adenocarcinoma.

* Although markedly atypical cells may be present there will not be many and there will be no single atypical cells

* Reactive cells will not have anisonucleosis and will not have nuclear irregularity

* Ductal cells out number acinar cells (acinar atrophy)

</spoiler>

* <spoiler text="Differential diagnosis?">__NOGLOSSARY__

* Adenocarcinoma

** Occurs later (6th and 7th decades)

** Irregular nuclear contours, macronuclei, anisonucleosis

** Positive staining for p53 and CDx-2

** Negative staining for SMAD4

* The presence of mitotic figures does not support the diagnosis of carcinoma. Mitotic figures can be seen in chronic pancreatitis.

* Pancreatic cancer is often surrounded by a zone of pancreatitis, therefore pancreatits does not exclude malignancy nor does inflammation

</spoiler>

[[Category:Unknowns]]

@@ Line 1: / Line 1: @@
+==Clinical History==
+year old male with weight loss and jaundice.
 ==Cytology==
 <gallery heights="333px" widths="333px">
@@ Line 8: / Line 11: @@
 CytologicallyYoursUnknowns201401-03-06.jpg
 </gallery>
+===Resident Questions===
+* <spoiler text="Diagnosis?">__NOGLOSSARY__
+* Chronic pancreatits
+** Occurs in the 4th and 5th decades
+** Clinically presents as chronic recurrent abdominal pain
+** Triad steatorrhea, diabetes mellitus, and weight loss
+** Can present as a solid mass in the head of the pancreas
+** Radiologically can appear as an ill defined lobulated mass and the periphery of the lesion can look irregular
+** Strictures of the biliary or pancreatic ducts occurs as well as calcification
+</spoiler>
+* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">__NOGLOSSARY__
+* Variable cellularity depending on the fibrosis in the specimen, however usually low cellularity
+* Smears are polymorphous (ductal cells, acinar cells, macrophages, inflammatory cells, fibrosis, debris, calcification, fat necrosis)
+* Hyperplastic and atypical ductal cells can be present, and can make it difficult to distinguish from adenocarcinoma.
+* Although markedly atypical cells may be present there will not be many and there will be no single atypical cells
+* Reactive cells will not have anisonucleosis and will not have nuclear irregularity
+* Ductal cells out number acinar cells (acinar atrophy)
+</spoiler>
+* <spoiler text="Differential diagnosis?">__NOGLOSSARY__
+* Adenocarcinoma
+** Occurs later (6th and 7th decades)
+** Irregular nuclear contours, macronuclei, anisonucleosis
+** Positive staining for p53 and CDx-2
+** Negative staining for SMAD4
+* The presence of mitotic figures does not support the diagnosis of carcinoma. Mitotic figures can be seen in chronic pancreatitis.
+* Pancreatic cancer is often surrounded by a zone of pancreatitis, therefore pancreatits does not exclude malignancy nor does inflammation
+</spoiler>
+{{Cytologically Yours}}
+[[Category:Unknowns]]