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

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

Resident Questions

• What was the initial diagnosis on rapid interpretation?

Adenocarcinoma.

Cell Block

• 
  40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.

• What stains do you order?

We ordered PSA, CK7, and CA19.9.

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Final Diagnosis

Cytology

• Metastatic prostate carcinoma.

• 
  20x magnification of PSA shows positive staining

• 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.