Cytologically Yours: CoW: 20140213

Clinical Summary

The patient is a 66yo old male presenting with jaundice.

Past Medical History

• History of prostate cancer 5 years ago.
• Hyperlipidemia
• Chronic back pain

Past Surgical History

• Prostatectomy (2009)
• Thyroidectomy (2004)

Ultrasound

• Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.

Clinical Plan

The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.

Pathology

Cytology

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  10x magnification of large cohesive groups of cells.
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  40x magnification showing atypical cells with large irregular nuclei.
• 
  20x magnification showing atypical cells with large irregular nuclei.
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  40x magnification showing large, markedly pleomorphic cells.
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  40x magnification of malignant cell groups.
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  60x magnification of malignant cells. Macronucleoli are easily identified.

Resident Questions

• The radiologic differential diagnosis was between osteosarcoma and Ewing sarcma. What would be a possible diagnostic pitfall?

The confusion between osteosarcoma and Ewing may occur with the small cell variant of osteosarcoma.

Click here to toggle the diagnosis and discussion.

Final Diagnosis

Cytology

• High grade sarcoma, favor osteosarcoma.

Biopsy

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  20x magnification of bone biopsy showing sclerotic bone.

Biopsy Diagnosis

• Conventional high grade sarcoma, sclerotic type.

Discussion

The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters.