WSI21-73: Pancreas and Biliary Tree
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Toggle columns: Diagnosis
| Case | Clinical history | Requester | Diagnosis |
|---|---|---|---|
| Case | Clinical history | Requester | Diagnosis |
|
| 39F • pancreatic body mass. | Iac0 | Solid pseudopapillary neoplasm. |
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| 57M. Pancreatic head cyst. | Iac0 | Small mature lymphocytes • consistent with lymphangioma. |
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| 33M. History of alveolar rhabdomyosarcoma. Now with pancreatic body mass. | Iac0 | Metastatic alveolar rhabdomyosarcoma |
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| 40-year-old female • pancreatic cyst fluid. CEA 8887 ng/mL. | Iac0 | Neoplastic mucinous cyst. Resection - Invasive adenocarcinoma arising in a mucinous cystic neoplasm with ovarian type stroma and dysplasia including high grade dysplasia. |
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| 60F. Pancreatic and abdominal wall mass. | Iac0 | Epithelioid gastrointestinal stromal tumor (GIST) with succinate dehydrogenase (SDH) deficiency. |
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| 57 yo man with a newly identified pancreatic head mass. | Cfh13 | Positive for malignant cells. Adenocarcinoma. |
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| 84 y.o male with very large 9 cm abdominal mass occupying the head and body of the pancreas. | Sxm | Serous cyst adenoma. |
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| 60 y.o female with a cyst in the uncinate process.
CEA0.6 • Amylase 190 | Sxm | Consistent with serous cystadenoma. VHL mutation. |
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| 16 mm multicystic mass in the pancreas tail. | Sxm | Serous cystadenoma.
-cuboidal • nonmucinous cyst lining cells. -PAS+ / dPAS- |
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| Pancreatic cyst. | Sxm | Serous cystadenoma |
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| 59F with pancreatic mass and liver mass. | Tz046 | A. PANCREATIC HEAD MASS: Pancreatic neuroendocrine tumor • grade 3. B. LIVER MASS CORE BIOPSY: Metastatic pancreatic neuroendocrine tumor. |
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| 2.5 cm cyst in the tail of the pancreas with mild septal enhancement | Est105 | Serous cystadenoma |
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| hx pancreatic mass | Est105 | adenocarcinoma |
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| hx pancreatic body mass | Est105 | acinar cell carcinoma |
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| 51F pancreatic tail mass. 3y post-Whipple resection for benign pancreatic cyst. | Iac0 | Abundant neutrophilic inflammation with rare fungal organisms • cytomorphologically consistent with Candida spp. |
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| 71M. Pancreatic head cyst. | Iac0 | Acellular mucin with ferning pattern • consistent with neoplastic mucinous cyst. |
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| 60 yo F w/ liver lesion | Ndk6 | Adenocarcinoma c/w biliary origins |
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| 31 yo M w/ cholangiocarcinoma | Ndk6 | Adenocarcinoma |
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| 71M. Peripancreatic mass. History of thyroid carcinoma. | Iac0 | Metastatic papillary thyroid carcinoma. |
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| 67-year-old man with pancreatic body cyst | Lt511 | Neoplastic mucinous cyst |
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| 55 yo F w/ mass in tail of pancreas and history of leiomyosarcoma | Ndk6 | Malignant spindle neoplasm consistent with metastatic leiomyosarcoma |
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| 81 yo M w/ painless jaundice | Ndk6 | SUSPICIOUS FOR MALIGNANT CELLS
High-grade biliary neoplasia. Note: The specimen shows high-grade glandular epithelium in papillary clusters • cribriforming groups and single cells. Mucinous cytoplasm is present. Background necrosis is not present. There is no subepithelial mucosa showing invasive glands • but an invasive carcinoma cannot be excluded. The findings support a diagnosis of at least high-grade biliary intraepithelial neoplasia. Immunostains submitted for review show retained nuclear staining with SMAD4 and low ki-67 proliferation index. |
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| 80 yo M w/ pancreas cyst | Ndk6 | A. FINE NEEDLE ASPIRATION BIOPSY • PANCREAS HEAD CYSTIC MASS: Adenocarcinoma associated with a high-grade papillary mucinous neoplasm.
B. PANCREAS HEAD CYSTIC MASS CORE BIOPSY: Adenocarcinoma. Note: Mucinous epithelium is present around and focally invasive of sclerotic stroma. Immunostains show the following profile: P53- wild-type staining • SMAD4- wild-type staining • P16- loss of nuclear staining supporting a mutation. C. PANCREAS HEAD CYST FLUID: NEOPLASTIC: OTHER- Mucinous cyst with high-grade features • at least high-grade dysplasia. |
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| 76 yo F w/ dilated pancreatic duct • signs of pancreatic divisum and fishmouth minor papilla • pancreatic head cystic mass (28.6 mm x 17.4 mm) abutting/communicating with the pancreatic duct at the head of the pancreas | Ndk6 | A. PANCREAS • HEAD • CYSTIC MASS:
NEOPLASTIC: OTHER Intraductal papillary mucinous neoplasm • low-grade. See note. Note: The aspirate and cellblock shows low-grade gastric-type mucinous epithelium without stroma. An H&E stain was prepared and reviewed in our laboratory to analyze unexamined tissue deeper in the block. In addition immunostains performed at MGH show the following profile: p53- wild -type • p16- retained • SMAD4- retained • MTAP- retained Correlation with imaging required. Any solid component or thick duct wall should be separately sampled. |
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| 79 yo M w/ known pancreatic adenocarcinoma and new body/tail lesion | Ndk6 | A. PANCREAS FINE NEEDLE ASPIRATION BIOPSY • BODY/TAIL LESION:
NEOPLASTIC: OTHER- Mucinous cyst fluid with high-grade epithelial atypia. Note: A mucinous etiology is established by cyst fluid CEA of 29 • 504 ng/mL and the high-grade mucinous epithelium. Background cellular necrosis is present. Invasive carcinoma is in the differential diagnosis. |
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| 63 yo F with pancreatic head mass | Ndk6 | Adenocarcinoma |
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| 78 yo F gallbladder mass FNA | Ndk6 | Adenocarcinoma |
