Cytologically Yours: CoW: 20140213: Difference between revisions

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Created page with "== Clinical Summary == The patient is a 66yo old male presenting with jaundice. === Past Medical History === * History of prostate cancer 5 years ago. * Hyperlipidemia * Chr..."
 
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====Resident Questions====
====Resident Questions====
* <spoiler text="The radiologic differential diagnosis was between osteosarcoma and Ewing sarcma. What would be a possible diagnostic pitfall?"> The confusion between osteosarcoma and Ewing may occur with the small cell variant of osteosarcoma.  </spoiler>
* <spoiler text="What was the initial diagnosis on rapid interpretation?"> Adenocarcinoma.  </spoiler>


====Cell Block====
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140213Biopsy1.jpg|40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.
</gallery>
* <spoiler text="What stains do you order?"> We ordered PSA, CK7, and CA19.9.  </spoiler>


<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div>
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div>
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==Final Diagnosis==
==Final Diagnosis==
===Cytology===
===Cytology===
* '''High grade sarcoma, favor osteosarcoma'''.
* '''Metastatic prostate carcinoma'''.
 


===Biopsy===
<gallery heights="250px" widths="250px">
<gallery heights="250px" widths="250px">
CytologicallyYoursCoW20140206Biopsy1.jpg|20x magnification of bone biopsy showing sclerotic bone.
CytologicallyYoursCoW20140213Biopsy2.jpg|20x magnification of PSA shows positive staining


</gallery>
</gallery>


===Biopsy Diagnosis===
* CK7 Negative
* '''Conventional high grade sarcoma, sclerotic type'''.
* CA19.9 Negative
* PSA Positive




===Discussion===
===Discussion===
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters.  
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.


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Latest revision as of 17:22, 4 March 2014

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


Resident Questions

Cell Block

  • 40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.
    40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.
Click here to toggle the diagnosis and discussion.

Final Diagnosis

Cytology

  • Metastatic prostate carcinoma.
  • 20x magnification of PSA shows positive staining
    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.

Cases of the Week
Unknowns
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