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