Difference between revisions of "Cytologically Yours: Unknowns: 201401: Case 2"
| Line 8: | Line 8: | ||
CytologicallyYoursUnknowns201401-02-06.jpg | CytologicallyYoursUnknowns201401-02-06.jpg | ||
</gallery> | </gallery> | ||
| + | |||
| + | ===Resident Questions=== | ||
| + | * <spoiler text="Diagnosis?"> | ||
| + | * Pancreatic Endocrine Neoplasm | ||
| + | ** Include Islet cell tumor and pancreatic carcinoid tumors | ||
| + | ** Approximately 5% of pancreatic neoplasms | ||
| + | ** Most commonly seen in both male and female adults between 40-60 years old but can occur at any age | ||
| + | ** Small (1-5 cm) well circumscribed lesion may look cystic on imaging | ||
| + | ** Commonly seen in the tail of the pancreas | ||
| + | ** Can be part of Multiple Endocrine Neoplasia-1, von Hipple-Lindau disease, Neurofibromatosis type 1, Tuberous Sclerosis Complex | ||
| + | </spoiler> | ||
| + | * <spoiler text="What are some of the cytologic features that lead you to the diagnosis?"> | ||
| + | * Cellular smear with singly dispersed uniform cells | ||
| + | * Loosely cohesive or discohesive uniform cells | ||
| + | * Cells are uniform, plasmacytoid with abundant finely granular cytoplasm | ||
| + | * Background is clean | ||
| + | * Occasional pleomorphism can be seen | ||
| + | * Round/oval bland cells with salt and pepper chromatin | ||
| + | </spoiler> | ||
| + | * <spoiler text="Differential diagnosis?"> | ||
| + | * Acinar cell carcinoma | ||
| + | ** Clusters, acinar groups and single cells with abundant granular cytoplasm and prominent nucleoli | ||
| + | ** Lack salt and pepper chromatin | ||
| + | ** Positive staining for trypsin, chymotrypsin and alpha-1-antichymotrypsin | ||
| + | ** Negative for neuroendocrine markers | ||
| + | * Solid Pseudopapillary Neoplasm | ||
| + | ** May see hyaline globules and clear cytoplasmic vacuoles | ||
| + | ** Branching papillary clusters with distinct central fibrovascular cores, but this can be seen in PEN too | ||
| + | ** Positive for vimentin, CD10, beta catenin, neuron specific enolase, CD56 | ||
| + | ** Negative for keratin markers | ||
| + | * Plasmacytoma | ||
| + | ** Look for a perinuclear hof and clock face chromatin | ||
| + | ** Positive staining for CD138 | ||
| + | ** Negative for neuroendocrine markers | ||
| + | * Islet cell hyperplasia | ||
| + | ** Difficult/ impossible to distinguish from islet cell tumor by cytology alone | ||
| + | * Melanoma | ||
| + | ** Can see melanin pigment in the cytoplasm but not always | ||
| + | ** Melanoma cytomorphology can be quite diverse | ||
| + | ** Positive for MART-1, HMB45, MITF | ||
| + | ** Negative for neuroendocrine markers | ||
| + | </spoiler> | ||
| + | *<spoiler text="What ancillary studies would you order?"> | ||
| + | * Neuroendocrine markers | ||
| + | ** CD56 | ||
| + | ** Synaptophysin | ||
| + | ** Chromogranin | ||
| + | * Cytokeratin | ||
| + | * TTF-1 | ||
| + | * Markers specific to peptide production | ||
| + | </spoiler> | ||
