Difference between revisions of "Cytologically Yours: Unknowns: 201401: Case 5"

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

Latest revision as of 20:10, 16 January 2014

Clinical History

58 year old female with a pancreatic mass.

Cytology

Resident Questions