Cytologically Yours: Unknowns: 201401: Case 6

Cytology

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Resident Questions

• 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

• 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

• 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

Chronic inflammation of the pancreas (pancreatitis) is most often caused by alcoholism or biliary tract calculi.

Jaundice (or icterus) is a state of hyperbilirubinemia (increased bilirubin in the blood) in which bile pigment is deposited in the skin, mucous membranes, and scleras. This deposition of bile pigment results in a yellow appearance.