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===Resident Questions===* <spoiler text="Diagnosis?">* 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</spoiler>* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">* Variable acute and chronic inflammation* Histiocytes* Giant cells* Necrotic debris* Granulation tissue may be present* No epithelium with atypia</spoiler>* <spoiler text="Differential diagnosis?"> * 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</galleryspoiler>
