Clinical History
45 year old male with weight loss and jaundice.
Cytology
Resident Questions
- 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
- 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)
- 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
