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Slide Seminar 03 - Pancreas Pathology
Sunday, September 17, 2006 08:00 - 12:00
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Moderators:
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Dr. Ralph H. Hruban and Dr. Günter Klöppel
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Disclosure:
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In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Slide Seminar) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. Faculty members for this Slide Seminar have indicated they have no disclosures to make.
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Clinical histories are displayed below.
Click on the case numbers to display the text and references for each case.
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- Pancreatic Mucinous Cystadenoma
Submitted by: Dr. Benoît Terris
A 22-year-old female with no medical history was admitted to our hospital for further examination of anemia. She had no evidence of gastrointestinal bleeding such as hematemesis. On admission, she was slightly pale and an abdominal mass was palpable. Laboratory examination confirmed the anemia (haemoglobin 7.4g/dl, hematocrit 25;2% and MCV 85 fl). Upper gastrointestinal endoscopy revealed nodular oesophageal and gastric varices with red spots suggesting stigmata of bleeding. On abdominal CT, the tail of the pancreas revealed a 10cm unilocular cystic lesion with irregular walls and septations. Mild splenomegaly, obstruction of splenic vein and gastrooesophageal varices were also observed. A clinical diagnosis of pancreatic cystadenocarcinoma was proposed. The patient underwent a distal pancreatectomy. Macroscopically, the tail of pancreas was occupied by a 10cm unilocular cyst showing numerous septa and filled with serosanguineous fluid. The inner lining of the cystic space did not show nodular masses. The selected slide concerns the cyst wall.
Case 1 - Figure 1
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- Acinar Cell Cystadenoma (ACA)
Submitted by: Dr. Giuseppe Zamboni
33-year-old girl: the patient presented with a history of abdominal pain. CT of the abdomen revealed an olygocystic lesion in the head of the pancreas, with focal peripheral calcifications. Endoscopic retrograde cholangiopancreatography revealed no communication between the cystic lesion and the ductal system. There was any evidence of cystic fibrosis, von Hippel-Lindau syndrome or polycistic kidney disease. A Whipple resection was performed.
Case 2 - Figure 1
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- Mixed Acinar-endocrine Carcinoma (MAEC) of the Pancreas
Submitted by: D. Klimstra
The patient is a 51 year old female with a history of chronic pancreatitis for several years who was found to have a 2.5 cm partially cystic mass in the head of the pancreas. A pancreatoduodenectomy was performed. Grossly, the pancreatic ducts were dilated and focally filled with soft tan solid nodules. Similar tumor nodules were found surrounded by densely fibrotic pancreatic parenchyma.
Case 3 - Figure 1
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- Mixed Acinar-endocrine Carcinoma (MAEC) of the Pancreas
Submitted by: Drs. Toshio Morohoshi and Nobuyuki Ohike
51-year old female patient. Large tumor in the tail of the pancreas and liver metastases were known for a year. There was a markedly elevated elastase 1 level (40,000 ng/dl), while CEA and CA19-9 levels were normal The patient died of hemorrhage from the pancreatic tumor. The present tumor tissue is autopsy material.
Case 3 - Figure 2
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- Intraductal Oncocytic Papillary Neoplasm with Carcinoma In-situ
Submitted by: Dr. N. Volkan Adsay
74-year old male had an 8 cm cystic lesion that contained nodular areas, located in the body of the pancreas.
Case 4 - Figure 1
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- Poorly Differentiated Neuroendocrine Carcinoma of the Pancreas Producing Somatostatin
Submitted by: Dr. Günter Klöppel
48-year-old male patient. Admission to hospital because of continuously increasing jaundice of one-week duration. Laparotomy because of suspected carcinoma in the head of the pancreas. Removal of tumor tissue.
Case 5 - Figure 1
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- Combined Serous Cystadenoma and Well-differentiated Pancreatic Endocrine Carcinoma in a Patient with Von Hippel-lindau Disease
Submitted by: Dr. Benoît Terris
A 34-year-old female underwent a computed tomography scan for chronic postprandial abdominal pain. Her past medical history included retinal and cerebellar hemangioblastomas and a resection of a clear cell carcinoma of the kidney six years before. CT scan showed a pancreas entirely replaced by numerous cysts of various sizes compressing the main pancreatic duct. Intermingled within the cysts, an hypervascular mass of 32 mm was present in the head of the pancreas. A duodenopancreatectomy with pancreaticogastric anastomosis was performed. At macroscopic examination the pancreas was entirely involved by multilocular cysts containing serous fluid. Some cystic lesions showed central scars. A solid yellow tumor of more than 3cm was observed in the head of the pancreas at proximity of the duodenal wall. At distance a second centimetric tumor was detected. The selected slide concerns the cystic pancreatic lesions and the largest nodule.
Case 6 - Figure 1
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