Difference between revisions of "Cytologically Yours: CoW: 20140213"

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====Resident Questions====
 
====Resident Questions====
* <spoiler text="What is your initial diagnosis?"> This was initially called adenocarcinoma on rapid diagnosis during the endoscopic ultrasound guided procedure. </spoiler>
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* <spoiler text="What was the initial diagnosis on rapid interpretation?"> Adenocarcinoma.   </spoiler>
  
===Cell Block===
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====Cell Block====
 
<gallery heights="250px" widths="250px">
 
<gallery heights="250px" widths="250px">
 
CytologicallyYoursCoW20140213Biopsy1.jpg|40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.
 
CytologicallyYoursCoW20140213Biopsy1.jpg|40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.
  
* <spoiler text="What special stains do you order?"> </spoiler>
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</gallery>
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* <spoiler text="What stains do you order?"> We ordered PSA, CK7, and CA19.9.  </spoiler>
  
 
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div>
 
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div>
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* '''Metastatic prostate carcinoma'''.
 
* '''Metastatic prostate carcinoma'''.
  
 
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CytologicallyYoursCoW20140213Biopsy2.jpg|20x magnification of PSA shows positive staining
  
 
</gallery>
 
</gallery>
  
===Biopsy Diagnosis===
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* CK7 Negative
* '''Conventional high grade sarcoma, sclerotic type'''.
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* CA19.9 Negative
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* PSA Positive
  
  
 
===Discussion===
 
===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.  
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Metastatic prostate carcinoma to the pancreas is rare; however, long term survival of prostate cancer may increase the incidence. Renal cell carcinoma is the most metastatic pancreatic tumor.
  
 
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Latest revision as of 22:22, 4 March 2014

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


Resident Questions


Cell Block


Click here to toggle the diagnosis and discussion.

Final Diagnosis

Cytology

  • Metastatic prostate carcinoma.
  • CK7 Negative
  • CA19.9 Negative
  • PSA Positive


Discussion

Metastatic prostate carcinoma to the pancreas is rare; however, long term survival of prostate cancer may increase the incidence. Renal cell carcinoma is the most metastatic pancreatic tumor.