Difference between revisions of "Cytologically Yours: Unknowns: 201401: Case 1"

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==Clinical History==
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72 year old female with jaundice and a pancreatic mass.
  
 
==Cytology==
 
==Cytology==
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===Resident Questions===
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* <spoiler text="Diagnosis?">__NOGLOSSARY__
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* Adenocarcinoma
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** Most common malignant tumor of the pancreas
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** Accounts for approximately 85% of all pancreatic tumors
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** Patients are commonly women in the 6th and 7th decades of life
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** Prognosis is poor
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*** 90% of patients die within a year of diagnosis
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** Association with cigarette smoking, high fat diet, and diabetes mellitus
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** Triad of weight loss, pain, and jaundice
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** Usually involve the head of the pancreas
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** Can obstruct the biliary or pancreatic ducts which can cause a double duct sign on imaging and can also cause painless jaundice
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</spoiler>
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* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">__NOGLOSSARY__
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* Cellular specimen
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* Predominantly ductal type cells and sparse/absent acinar cells
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* Pleomorphism
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* Nuclear crowding and overlapping
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* Nuclear enlargement (more than 2-3 times the size of red blood cells)
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* Nuclear membrane irregularity
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* Three dimensional configuration
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* Drunken honeycomb
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</spoiler>
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* <spoiler text="Differential diagnosis?">__NOGLOSSARY__
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* Chronic pancreatitis
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** Occurs in 4th and 5th decades
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** Lack of irregular nuclear contours, macronuclei, anisonucleosis
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** Monolayer fragments with honeycomb pattern
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** Cells with well defined cell borders
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** Negative staining for p53 and CDx-2
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** Positive staining for SMAD4
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* Contaminant gastrointestinal epithelium
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** Gastric
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*** Monolayered tissue fragments with honeycomb arrangement
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*** Uniform nuclei
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*** Luminal Brush border
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** Intestinal
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*** Large monolayered two dimensional tissue fragments
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*** Honeycomb arrangement of cells
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*** Intermixed goblet cells
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*** Uniform round evenly spaced nuclei
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** Positive staining for CDX-2 and SMAD4
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** Negative staining for p53
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* The presence of mitotic figures does not support the diagnosis of carcinoma. Mitotic figures can be seen in chronic pancreatitis.
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</spoiler>
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{{Cytologically Yours}}
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[[Category:Unknowns]]

Latest revision as of 20:14, 16 January 2014

Clinical History

72 year old female with jaundice and a pancreatic mass.

Cytology

Resident Questions