Cytologically Yours: Unknowns: 201401: Case 5: Difference between revisions - Pathology Education Instructional Resource

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===Resident Questions===

* <spoiler text="Diagnosis?">

* Mucinous Pancreatic Neoplasm

** Includes two diagnostic entities:

*** Mucinous Cystic Neoplasm (MCN)

**** Most arise in the body and tail of the pancreas

**** Most occur in women between the ages of 40 and 50 years old

**** Do not arise from the pancreatic main duct

*** Intraductal Papillary Mucinous Neoplasm (IPMN)

**** Most arise in the head of the pancreas

**** Most occur in men older than 60 years old

**** Connect to the pancreatic main duct or one of its branches

**** Radiology shows dilatation of the pancreatic duct and its branches

**** Endoscopy will reveal thick mucin extruding from the ampulla

** Both are considered high risk due to their association with dysplasia and underlying carcinoma

** Distinction between the two on cytology alone is not recommended

** Best diagnosis is "neoplastic cells present, pancreatic mucinous neoplasm"

</spoiler>

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

* Abundant thick mucin that may look colloid like

* Mucin can be so thick and tenacious it may cause difficulty in aspirating and making smears

* Flat sheets and clusters of bland appearing columnar cells with abundant intracytoplasmic mucin

* Mucin fills the cytoplasm and displaces the nucleus to the periphery or base of the cell. This is unlike the apical mucin seen in gastric foveolar epithelium

* Atypia may be present depending on the presence and degree of dysplasia

* Single cells or groups trapped in mucus

</spoiler>

* <spoiler text="Differential diagnosis?">

* Contaminant gastrointestinal

** Brush border and interspersed goblet cells is seen in duodenal epithelium

** May see abundant mucin from GI tract

** Gastric epithelium is present in tissue fragments of uniform cuboidal cells

** Punctate perinuclear staining with B72.3

* CAN NOT DIFFERENTIATE BETWEEN IPMN AND MCN ON CYTOLOGY ALONE

</spoiler>

*<spoiler text="What ancillary studies would you order?">

* CEA levels are >200ng/mL in both MCN and IPMN

* Amylase will be high in IPMN and low in MCN (due to IPMN connection with the pancreatic duct)

* B72.3 has diffuse cytoplasmic staining in MCN and IPMN

</spoiler>

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 CytologicallyYoursUnknowns201401-05-05.jpg
 CytologicallyYoursUnknowns201401-05-06.jpg
+</gallery>
-</gallery>
+===Resident Questions===
+* <spoiler text="Diagnosis?">
+* Mucinous Pancreatic Neoplasm
+** Includes two diagnostic entities:
+*** Mucinous Cystic Neoplasm (MCN)
+**** Most arise in the body and tail of the pancreas
+**** Most occur in women between the ages of 40 and 50 years old
+**** Do not arise from the pancreatic main duct
+*** Intraductal Papillary Mucinous Neoplasm (IPMN)
+**** Most arise in the head of the pancreas
+**** Most occur in men older than 60 years old
+**** Connect to the pancreatic main duct or one of its branches
+**** Radiology shows dilatation of the pancreatic duct and its branches
+**** Endoscopy will reveal thick mucin extruding from the ampulla
+** Both are considered high risk due to their association with dysplasia and underlying carcinoma
+** Distinction between the two on cytology alone is not recommended
+** Best diagnosis is "neoplastic cells present, pancreatic mucinous neoplasm"
+</spoiler>
+* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">
+* Abundant thick mucin that may look colloid like
+* Mucin can be so thick and tenacious it may cause difficulty in aspirating and making smears
+* Flat sheets and clusters of bland appearing columnar cells with abundant intracytoplasmic mucin
+* Mucin fills the cytoplasm and displaces the nucleus to the periphery or base of the cell. This is unlike the apical mucin seen in gastric foveolar epithelium
+* Atypia may be present depending on the presence and degree of dysplasia
+* Single cells or groups trapped in mucus
+</spoiler>
+* <spoiler text="Differential diagnosis?">
+* Contaminant gastrointestinal
+** Brush border and interspersed goblet cells is seen in duodenal epithelium
+** May see abundant mucin from GI tract
+** Gastric epithelium is present in tissue fragments of uniform cuboidal cells
+** Punctate perinuclear staining with B72.3
+* CAN NOT DIFFERENTIATE BETWEEN IPMN AND MCN ON CYTOLOGY ALONE
+</spoiler>
+*<spoiler text="What ancillary studies would you order?">
+* CEA levels are >200ng/mL in both MCN and IPMN
+* Amylase will be high in IPMN and low in MCN (due to IPMN connection with the pancreatic duct)
+* B72.3 has diffuse cytoplasmic staining in MCN and IPMN
+</spoiler>