Cytologically Yours: Unknowns: 201401: Case 1
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Clinical History
72 year old female with jaundice and a pancreatic mass.
Cytology
Resident Questions
- <spoiler text="Diagnosis?">
- Adenocarcinoma
- Most common malignant tumor of the pancreas
- Accounts for approximately 85% of all pancreatic tumors
- Patients are commonly women in the 6th and 7th decades of life
- Prognosis is poor
- 90% of patients die within a year of diagnosis
- Association with cigarette smoking, high fat diet, and diabetes mellitus
- Triad of weight loss, pain, and jaundice
- Usually involve the head of the pancreas
- Can obstruct the biliary or pancreatic ducts which can cause a double duct sign on imaging and can also cause painless jaundice
</spoiler>
- <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">
- Cellular specimen
- Predominantly ductal type cells and sparse/absent acinar cells
- Pleomorphism
- Nuclear crowding and overlapping
- Nuclear enlargement (more than 2-3 times the size of red blood cells)
- Nuclear membrane irregularity
- Three dimensional configuration
- Drunken honeycomb
</spoiler>
- <spoiler text="Differential diagnosis?">
- Chronic pancreatitis
- Occurs in 4th and 5th decades
- Lack of irregular nuclear contours, macronuclei, anisonucleosis
- Monolayer fragments with honeycomb pattern
- Cells with well defined cell borders
- Negative staining for p53 and CDx-2
- Positive staining for SMAD4
- Contaminant gastrointestinal epithelium
- Gastric
- Monolayered tissue fragments with honeycomb arrangement
- Uniform nuclei
- Luminal Brush border
- Intestinal
- Large monolayered two dimensional tissue fragments
- Honeycomb arrangement of cells
- Intermixed goblet cells
- Uniform round evenly spaced nuclei
- Positive staining for CDX-2 and SMAD4
- Negative staining for p53
- Gastric
- The presence of mitotic figures does not support the diagnosis of carcinoma. Mitotic figures can be seen in chronic pancreatitis.
</spoiler>
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