RESIDENT CASE STUDIES

Week 7 June 2 - June 6, 2003: Case 2   

Table of Contents | List of Diagnoses | Case 1 | Case 2 | Case 3 | Case 4

54 year old white male with pancreatic mass. The distal pancreatectomy specimen contains a multinodular, well encapsulated, tan-yellow 7.5 x 6.8 x 6.5cm mass. This was a highly cellular aspirate with monotonous aggregates and single cell population on cytology. 

Discussion: 
Pancreatic endocrine neoplasms (PEN) exhibit a monotonous population of small-medium size cells with a round-oval nucleus, abundant finely granular eosinophilic cytoplasm, distinct nucleoli & stippled chromatin. 

Pancreatoblastoma: Is the most common pancreatic tumor of childhood with squamoid cell nests (corpuscles) which are scattered throughout the tumor and may show central keratinization. 

PEN: Uncommon (<2% of pancreatic neoplasms); 60-80% are functional (insulinomas 30-70%, gastrinomas 25%); non-functional PEN are generally larger (4-6cm) because they  are asymptomatic until their large size produces symptoms instead of hormones; typical neuroendocrine appearance of cells. 

Chronic pancreatitis with islet cell hyperplasia: Islet cells scattered throughout the pancreas (not a single discrete mass); stromal fibrosis, acinar destruction, and chronic inflammation. 

Acinic cell carcinoma: Larger cells with abundant granular cytoplasm; poorly circumscribed nodules separated by fibrous septa; may be multicystic; often invades adjacent organs. 

Solid-pseudopapillary tumor: Usually in young females; pseudopapillary areas alternate with solid areas.

References:

Wenig Bruce M. Atlas of endocrine pathology / Bruce M. Wenig, Clara S. Heffess, Carol F. Adair.