Clinical History
47 year old male with a pancreatic mass.
Cytology
Resident Questions
- Pseudocyst
- Most common cystic lesion
- Etiology is diverse (acute pancreatitis, recurrent chronic pancreatitis, trauma, chronic alcohol abuse)
- Clinically patients present with jaundice, pain, nausea, vomiting, weight loss
- Pathogenesis
- leakage of pancreatic enzymes into parenchyma
- necrosis and chemical peritonitis
- inflammatory response and pancreatic secretion accumulation occurs and fibrous tissue walls off irritants which causes cyst formation
- Localized collection of amylase rich pancreatic secretions, necrotic debris and blood
- Most occur in the tail of the pancreas
- Usually solitary and unilocular
- Lack a true epithelial lining
- Variable acute and chronic inflammation
- Histiocytes
- Giant cells
- Necrotic debris
- Granulation tissue may be present
- No epithelium with atypia
- Ductal adenocarcinoma with cystic degeneration
- Atypia in the epithelium
- Pleomorphic nuclei, cytoplasm variable (vacuolated to dense)
- Cellular inflammatory background
- Positive CEA and cytokeratin
- Any neoplasm will have epithelial groups and single cells with atypia
- Big diagnostic problem is the atypia that can be seen in the granulation tissue
