Cytologically Yours: Unknowns: 201401: Case 2: Difference between revisions
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==Clinical History== | |||
52 year old female with a pancreatic head mass. | |||
==Cytology== | ==Cytology== | ||
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===Resident Questions=== | |||
* <spoiler text="Diagnosis?">__NOGLOSSARY__ | |||
* Pancreatic Endocrine Neoplasm | |||
** Include Islet cell tumor and pancreatic carcinoid tumors | |||
** Approximately 5% of pancreatic neoplasms | |||
** Most commonly seen in both male and female adults between 40-60 years old but can occur at any age | |||
** Small (1-5 cm) well circumscribed lesion may look cystic on imaging | |||
** Commonly seen in the tail of the pancreas | |||
** Can be part of Multiple Endocrine Neoplasia-1, von Hipple-Lindau disease, Neurofibromatosis type 1, Tuberous Sclerosis Complex | |||
</spoiler> | |||
* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">__NOGLOSSARY__ | |||
* Cellular smear with singly dispersed uniform cells | |||
* Loosely cohesive or discohesive uniform cells | |||
* Cells are uniform, plasmacytoid with abundant finely granular cytoplasm | |||
* Background is clean | |||
* Occasional pleomorphism can be seen | |||
* Round/oval bland cells with salt and pepper chromatin | |||
</spoiler> | |||
* <spoiler text="Differential diagnosis?">__NOGLOSSARY__ | |||
* Acinar cell carcinoma | |||
** Clusters, acinar groups and single cells with abundant granular cytoplasm and prominent nucleoli | |||
** Lack salt and pepper chromatin | |||
** Positive staining for trypsin, chymotrypsin and alpha-1-antichymotrypsin | |||
** Negative for neuroendocrine markers | |||
* Solid Pseudopapillary Neoplasm | |||
** May see hyaline globules and clear cytoplasmic vacuoles | |||
** Branching papillary clusters with distinct central fibrovascular cores, but this can be seen in PEN too | |||
** Positive for vimentin, CD10, beta catenin, neuron specific enolase, CD56 | |||
** Negative for keratin markers | |||
* Plasmacytoma | |||
** Look for a perinuclear hof and clock face chromatin | |||
** Positive staining for CD138 | |||
** Negative for neuroendocrine markers | |||
* Islet cell hyperplasia | |||
** Difficult/ impossible to distinguish from islet cell tumor by cytology alone | |||
* Melanoma | |||
** Can see melanin pigment in the cytoplasm but not always | |||
** Melanoma cytomorphology can be quite diverse | |||
** Positive for MART-1, HMB45, MITF | |||
** Negative for neuroendocrine markers | |||
</spoiler> | |||
*<spoiler text="What ancillary studies would you order?"> | |||
* Neuroendocrine markers | |||
** CD56 | |||
** Synaptophysin | |||
** Chromogranin | |||
* Cytokeratin | |||
* TTF-1 | |||
* Markers specific to peptide production | |||
</spoiler> | |||
{{Cytologically Yours}} | |||
[[Category:Unknowns]] | |||