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[[Image:Gray 1100 Pancreatic duct.png|thumb|right|250px|A drawing of the pancreas. (WC/Gray's Anatomy)]] | |||
The '''pancreas''' hangs-out in the upper abdomen. It occasionally is afflicited by cancers, the most common of which is very fatal. | The '''pancreas''' hangs-out in the upper abdomen. It occasionally is afflicited by cancers, the most common of which is very fatal. | ||
A general introduction to | Pancreatic cytopathology is dealt with in the ''[[gastrointestinal cytopathology]]'' article. | ||
A general introduction to gastrointestinal pathology is in the ''[[gastrointestinal pathology]]'' article. | |||
=Introduction= | =Introduction= | ||
==Normal anatomy== | ==Normal anatomy== | ||
Divided into three portions: head, body & tail: | Divided into three portions: head, body & tail:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/PancreasEndo_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/PancreasEndo_11protocol.pdf]. Accessed on: 29 March 2012.</ref> | ||
*Head: | *Head: | ||
**Includes unicate process. | **Includes unicate process. | ||
** | **Extends to the left edge of the superior mesenteric vein (SMV) - by definition. | ||
***All of the SMV is with the head. | |||
*Body: | *Body: | ||
** | **Right edge of the superior mesenteric vein to the left edge of aorta - by definition. | ||
***All of the aorta is with the body. | |||
*Tail: | *Tail: | ||
**Remainder of pancreas. | **Remainder of pancreas. | ||
Line 16: | Line 21: | ||
==Pancreatic surgeries== | ==Pancreatic surgeries== | ||
Common pancreatic surgeries include: | Common pancreatic surgeries include: | ||
*Whipple (includes duodenum). | *Whipple procedure ([[AKA]] pancreaticoduodenal resection) - includes [[duodenum]] and usually the distal [[stomach]] (antrum). | ||
*Distal pancreatectomy. | *Distal pancreatectomy. | ||
**Removal of tail +/- body. | **Removal of tail +/- body. | ||
**Specimen usually comes with | **Specimen usually comes with the [[spleen]]. | ||
**Typically done form [[islet cell tumour]]s. | |||
*Total pancreatectomy. | *Total pancreatectomy. | ||
**Specimen usually comes with | **Specimen usually comes with the spleen. | ||
===Whipple procedure=== | |||
*[[AKA]] ''pancreaticoduodenectomy''. | |||
Indications: | |||
*Head of pancreas lesions, duodenal lesions. | |||
[[Margins]]:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SmallbowelNET_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SmallbowelNET_11protocol.pdf]. Accessed on: 29 March 2012.</ref> | |||
#Proximal mucosal margin (stomach or duodenum). | |||
#Distal mucosal margin (duodenum or jejunum). | |||
#Bile duct margin. | |||
#Pancreatic retroperitoneal (uncinate process) margin. | |||
#*At SB done ''on edge'' (not ''en face''). | |||
#Pancreatic neck transection margin ([[AKA]] distal pancreatic resection margin);<ref name=pmid20485150>{{Cite journal | last1 = Jamieson | first1 = NB. | last2 = Foulis | first2 = AK. | last3 = Oien | first3 = KA. | last4 = Going | first4 = JJ. | last5 = Glen | first5 = P. | last6 = Dickson | first6 = EJ. | last7 = Imrie | first7 = CW. | last8 = McKay | first8 = CJ. | last9 = Carter | first9 = R. | title = Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma. | journal = Ann Surg | volume = 251 | issue = 6 | pages = 1003-10 | month = Jun | year = 2010 | doi = 10.1097/SLA.0b013e3181d77369 | PMID = 20485150 }}</ref> usu. ''en face'' and ''in toto''.<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/PancreasEndo_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/PancreasEndo_11protocol.pdf]. Accessed on: 6 April 2012.</ref> | |||
#Sometimes superior mesenteric vein (SMV). | |||
#Rarely superior mesenteric artery (SMA) margin. | |||
[[Opening]]: | |||
#Open the proximal (stomach) and distal (small bowel) stappled margins. | |||
#Open the duodenum along it length on the anterior aspect. | |||
#Open the stomach along the greater curvature. | |||
#Join the cuts that open the stomach and duodenum. | |||
==General classification of pancreatic tumours== | ==General classification of pancreatic tumours== | ||
Line 41: | Line 60: | ||
===Pancreas neoplasms in a table=== | ===Pancreas neoplasms in a table=== | ||
{| class="wikitable" | {| class="wikitable sortable" | ||
!| Type | !| Type | ||
!| Key feature | !| Key feature | ||
Line 55: | Line 74: | ||
| cuboidal cells, clear cytoplasm | | cuboidal cells, clear cytoplasm | ||
| cystadenoma, borderline t., cystadenocarcinoma | | cystadenoma, borderline t., cystadenocarcinoma | ||
| [http://commons.wikimedia.org/wiki/File:Pancreatic_serous_cystadenoma_%281%29.jpg], [http://commons.wikimedia.org/wiki/File:Pancreatic_serous_cystadenoma_%282%29.jpg], [http://commons.wikimedia.org/wiki/File:Pancreatic_serous_cystadenoma_-_intermed_mag.jpg] | | [http://commons.wikimedia.org/wiki/File:Pancreatic_serous_cystadenoma_%281%29.jpg], [http://commons.wikimedia.org/wiki/File:Pancreatic_serous_cystadenoma_%282%29.jpg (WC)], [http://commons.wikimedia.org/wiki/File:Pancreatic_serous_cystadenoma_-_intermed_mag.jpg (WC)] | ||
| IHC? | | IHC? | ||
| cuboidal cells, clear cytoplasm, central nucleus | | cuboidal cells, clear cytoplasm, central nucleus | ||
| body or tail | | body or tail | ||
| cystadenoma may be assoc. with [[von Hippel-Lindau syndrome]] | | cystadenoma may be assoc. with [[von Hippel-Lindau syndrome]] | ||
| clear cell RCC, oligomucinous mucinous tumours | | [[clear cell renal cell carcinoma|clear cell RCC]], oligomucinous mucinous tumours | ||
|- | |- | ||
| Intraductal papillary | | [[Intraductal papillary mucinous tumour]] (IPMT) | ||
| mucin, no ovarian-like stroma | | mucin, no ovarian-like stroma | ||
| clear cell variant | | clear cell variant | ||
Line 70: | Line 89: | ||
| head | | head | ||
| - | | - | ||
| mucious neoplasms (other pancreatic, duodenal) | | mucious neoplasms (other pancreatic, duodenal), intra-ampullary papillary-tubular neoplasm (see [[ampullary carcinoma]]) | ||
|- | |- | ||
| Mucinous tumour | | Mucinous tumour | ||
| mucin, ovarian-like stroma | | mucin, ovarian-like stroma | ||
| cystadenoma, borderline t., cystadenocarcinoma | | cystadenoma, borderline t., cystadenocarcinoma | ||
| [http://commons.wikimedia.org/w/index.php?title=File:Benign_pancreatic_mucinous_cystic_neoplasm_-_intermed_mag.jpg], [http://commons.wikimedia.org/w/index.php?title=File:Benign_pancreatic_mucinous_cystic_neoplasm_-_high_mag.jpg] | | [http://commons.wikimedia.org/w/index.php?title=File:Benign_pancreatic_mucinous_cystic_neoplasm_-_intermed_mag.jpg (WC)], [http://commons.wikimedia.org/w/index.php?title=File:Benign_pancreatic_mucinous_cystic_neoplasm_-_high_mag.jpg (WC)] | ||
| IHC? | | IHC? | ||
| tall columnar mucin-producing cells, ovarian-like stroma | | tall columnar mucin-producing cells, ovarian-like stroma | ||
| body or tail | | body or tail | ||
| - | | - | ||
| IPMT, metastatic mucinous tumours | | [[IPMT]], metastatic mucinous tumours | ||
|- | |- | ||
| [[Solid pseudopapillary tumour|Solid pseudopapillary<br>tumour]] | | [[Solid pseudopapillary tumour|Solid pseudopapillary<br>tumour]] | ||
| eosinophilic intracytoplasmic globules | | eosinophilic intracytoplasmic globules | ||
| clear cell variant (cytoplasm clear) | | clear cell variant (cytoplasm clear) | ||
| [http://commons.wikimedia.org/w/index.php?title=File:Solid_pseudopapillary_tumour_-_intermed_mag.jpg], [http://jcp.bmj.com/content/61/11/1153/F1.large.jpg] | | [http://commons.wikimedia.org/w/index.php?title=File:Solid_pseudopapillary_tumour_-_intermed_mag.jpg (WC)], [http://jcp.bmj.com/content/61/11/1153/F1.large.jpg (bmj.com)] | ||
| beta-catenin +ve, E-cadherin +ve, <br>synaptophysin +ve, chromogranin -ve | | beta-catenin +ve, E-cadherin +ve, <br>synaptophysin +ve, chromogranin -ve | ||
| sheets of cells, focally loosely cohesive, eosinophilic cytoplasm, uniform nuclei with grooves | | sheets of cells, focally loosely cohesive, eosinophilic cytoplasm, uniform nuclei with grooves | ||
| none | | none (head, body or tail) | ||
| usu. younger women | | usu. younger women | ||
| ductal adenocarcinoma, neuroendocrine | | [[pancreatic ductal adenocarcinoma|ductal adenocarcinoma]], [[neuroendocrine tumour]]s | ||
|- | |- | ||
| [[Invasive ductal carcinoma of the pancreas|Ductal adenocarcinoma]] | | [[Invasive ductal carcinoma of the pancreas|Ductal adenocarcinoma]] | ||
| irregular shaped glands, cytologic atypia | | irregular shaped glands, cytologic atypia | ||
| mucinous, spindle cell, mixed ductal-endocrine | | mucinous, spindle cell, mixed ductal-endocrine | ||
| [http://commons.wikimedia.org/wiki/File:Pancreas_adenocarcinoma_%284%29_Case_01.jpg], [http://commons.wikimedia.org/wiki/File:Pancreas_adenocarcinoma_%282%29_Case_01.jpg] | | [http://commons.wikimedia.org/wiki/File:Pancreas_adenocarcinoma_%284%29_Case_01.jpg (WC)], [http://commons.wikimedia.org/wiki/File:Pancreas_adenocarcinoma_%282%29_Case_01.jpg (WC)] | ||
| IHC? | | IHC? | ||
| glands, sheets, single cells, nuc. atypia, +/-mitoses, +/-[[necrosis]] | | glands, sheets, single cells, nuc. atypia, +/-mitoses, +/-[[necrosis]] | ||
| head | | head | ||
| arises from the precursor ''PanIN'' | | arises from the precursor ''PanIN'' | ||
| ampullary carcinoma, chronic pancreatitis | | ampullary carcinoma, [[chronic pancreatitis]] | ||
|- | |- | ||
| Pancreatoblastoma | | [[Pancreatoblastoma]] | ||
| squamoid nests, whorling | | squamoid nests, whorling | ||
| - | | - | ||
| | | [http://www.nature.com/modpathol/journal/v20/n1s/fig_tab/3800686f16.html#figure-title (nature.com)] | ||
| | | [[CK7]] (acinar comp.), CK8, CK18, [[CK19]] | ||
| squamoid nests of cells, whorling, nested growth, +/-keratinization | | squamoid nests of cells, whorling, nested growth, +/-keratinization | ||
| none | | none | ||
Line 115: | Line 134: | ||
| acinar arch. | | acinar arch. | ||
| - | | - | ||
| [http://www.histopathology-india.net/acinar%20cell%20ca.JPG] | | [http://commons.wikimedia.org/wiki/File:Acinar_cell_carcinoma_of_the_pancreas_-_very_high_mag.jpg (WC)], [http://www.histopathology-india.net/acinar%20cell%20ca.JPG (histopathology-india.net)] | ||
| | | trypsin, lipase | ||
| nests or [[trabeculae]], nucleolus, mod. basophilic granular cytoplasm | | nests or [[trabeculae]], nucleolus, mod. basophilic granular cytoplasm | ||
| head (slight predilection) | | head (slight predilection) | ||
Line 140: | Line 159: | ||
| ? | | ? | ||
| not a neoplasm, included here as it is in the (clinical) DDx | | not a neoplasm, included here as it is in the (clinical) DDx | ||
| ductal adenocarcinoma | | [[pancreatic ductal adenocarcinoma|ductal adenocarcinoma]] | ||
|} | |} | ||
Line 158: | Line 177: | ||
*[[Pancreatic ductal adenocarcinoma|Ductal adenocarcinoma]]. | *[[Pancreatic ductal adenocarcinoma|Ductal adenocarcinoma]]. | ||
**Mucinous noncystic carcinoma. | **Mucinous noncystic carcinoma. | ||
**Signet ring cell carcinoma. | **[[Signet ring cell carcinoma]]. | ||
**Adenosquamous carcinoma. | **[[Adenosquamous carcinoma]]. | ||
**Undifferentiated carcinoma. | **Undifferentiated carcinoma. | ||
**Undifferentiated carcinoma with osteoclast-like giant cells. | **Undifferentiated carcinoma with osteoclast-like giant cells. | ||
Line 183: | Line 202: | ||
==Pancreatic acinar metaplasia== | ==Pancreatic acinar metaplasia== | ||
*[[AKA]] pancreatic metaplasia. | *Abbreviated ''PAM''. | ||
*[[AKA]] ''pancreatic metaplasia''.<ref name=pmid8724024>{{Cite journal | last1 = Stachura | first1 = J. | last2 = Konturek | first2 = JW. | last3 = Urbanczyk | first3 = K. | last4 = Bogdal | first4 = J. | last5 = Mach | first5 = T. | last6 = Domschke | first6 = W. | title = Endoscopic and histological appearance of pancreatic metaplasia in the human gastric mucosa: a preliminary report on a recently recognized new type of gastric mucosal metaplasia. | journal = Eur J Gastroenterol Hepatol | volume = 8 | issue = 3 | pages = 239-43 | month = Mar | year = 1996 | doi = | PMID = 8724024 }}</ref> | |||
===General=== | ===General=== | ||
*Common in the GI tract. | *Common in the GI tract. | ||
*Found in ~ | *Found in ~ 17-19% of [[stomach|gastro]][[esophagus|esophageal]] junction biopsies.<ref name=pmid23989798/><ref name=pmid20012917>{{cite journal |author=Johansson J, Håkansson HO, Mellblom L, ''et al.'' |title=Pancreatic acinar metaplasia in the distal oesophagus and the gastric cardia: prevalence, predictors and relation to GORD |journal=J. Gastroenterol. |volume=45 |issue=3 |pages=291–9 |year=2010 |month=March |pmid=20012917 |doi=10.1007/s00535-009-0161-4 |url=}}</ref> | ||
*Associated with intestinal metaplasia.<ref name=pmid23989798>{{Cite journal | last1 = Schneider | first1 = NI. | last2 = Plieschnegger | first2 = W. | last3 = Geppert | first3 = M. | last4 = Wigginghaus | first4 = B. | last5 = Höss | first5 = GM. | last6 = Eherer | first6 = A. | last7 = Wolf | first7 = EM. | last8 = Rehak | first8 = P. | last9 = Vieth | first9 = M. | title = Pancreatic acinar cells-a normal finding at the gastroesophageal junction? Data from a prospective Central European multicenter study. | journal = Virchows Arch | volume = | issue = | pages = | month = Aug | year = 2013 | doi = 10.1007/s00428-013-1471-8 | PMID = 23989798 }}</ref> | |||
**Not associated with changes of [[GERD]], or [[Helicobacter gastritis]].<ref name=pmid23989798/> | |||
===Gross=== | |||
*May be a single lesion or a cluster of lesions.<ref name=pmid8724024/> | |||
Note: | |||
*''Not'' associated with the endoscopic diagnosis of esophagitis or [[Barrett's esophagus]].<ref name=pmid23989798/> | |||
===Microscopic=== | ===Microscopic=== | ||
Line 198: | Line 226: | ||
*No islets of Langerhans (pancreatic islets). | *No islets of Langerhans (pancreatic islets). | ||
Images | ====Images==== | ||
<gallery> | |||
Image:Pancreatic_acinar_metaplasia_-_high_mag.jpg | PAM - high mag. (WC/Nephron) | |||
Image:Pancreatic_acinar_metaplasia_-_low_mag.jpg | PAM - low mag. (WC/Nephron) | |||
</gallery> | |||
===IHC=== | |||
Features:<ref>{{Cite journal | last1 = Doglioni | first1 = C. | last2 = Laurino | first2 = L. | last3 = Dei Tos | first3 = AP. | last4 = De Boni | first4 = M. | last5 = Franzin | first5 = G. | last6 = Braidotti | first6 = P. | last7 = Viale | first7 = G. | title = Pancreatic (acinar) metaplasia of the gastric mucosa. Histology, ultrastructure, immunocytochemistry, and clinicopathologic correlations of 101 cases. | journal = Am J Surg Pathol | volume = 17 | issue = 11 | pages = 1134-43 | month = Nov | year = 1993 | doi = | PMID = 8214258 }}</ref> | |||
*Trypase +ve. | |||
*Lipase +ve. | |||
===Sign out=== | |||
It can be debated whether it is worth reporting. | |||
<pre> | |||
ESOPHAGUS (DISTAL), BIOPSY: | |||
- COLUMNAR EPITHELIUM WITH MODERATE CHRONIC, FOCALLY ACTIVE, INFLAMMATION, AND | |||
PANCREATIC ACINAR METAPLASIA. | |||
- REACTIVE SQUAMOUS EPITHELIUM. | |||
- NEGATIVE FOR INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
==Pancreatic ectopia== | ==Pancreatic ectopia== | ||
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Mnemonic ''I GET SMASHED'': | Mnemonic ''I GET SMASHED'': | ||
*Idiopathic. | *Idiopathic. | ||
*Gallstones ~45%. | *[[Gallstones]] ~45%. | ||
*Ethanol ~35%. | *Ethanol ~35%. | ||
*Tumours (pancreas, ampulla). | *Tumours (pancreas, ampulla). | ||
Line 228: | Line 273: | ||
*Surgery/trauma, e.g. ERCP, motor vehicle collision. | *Surgery/trauma, e.g. ERCP, motor vehicle collision. | ||
*Hypercalcemia, hyperlipidemia/hypertriglyceridemia, [[hypothermia]]. | *Hypercalcemia, hyperlipidemia/hypertriglyceridemia, [[hypothermia]]. | ||
*Emboli, e.g. post-CABG. | *Emboli, e.g. post-[[CABG]]. | ||
*Drugs - ''SAND'' = steroids & sulfonamides, azathioprine, | *Drugs - ''SAND'' = steroids & sulfonamides, azathioprine, [[NSAID]]s, diuretics, such as furosemide. | ||
==Acute pancreatitis== | ==Acute pancreatitis== | ||
{{Main|Acute pancreatitis}} | |||
==Chronic pancreatitis== | ==Chronic pancreatitis== | ||
{{Main|Chronic pancreatitis}} | |||
=Cystic lesions - overview= | =Cystic lesions - overview= | ||
Line 308: | Line 286: | ||
*True cystic lesions are uncommon. | *True cystic lesions are uncommon. | ||
**A true cystic lesion: ''must'' have an epithelial lining. | **A true cystic lesion: ''must'' have an epithelial lining. | ||
***Only 10% of cystic lesions are true cystic lesions, i.e. 90% of cystic lesions are really pseudocysts. | ***Only 10% of cystic lesions are true cystic lesions, i.e. 90% of cystic lesions are really [[Pancreatic pseudocyst|pseudocysts]]. | ||
*It is hard to differentiate pseudocysts & cysts. | *It is hard to differentiate pseudocysts & cysts. | ||
Line 341: | Line 319: | ||
===Cystic tumours of the pancreas=== | ===Cystic tumours of the pancreas=== | ||
Khalifa's table of cystic tumours: | Khalifa's table of cystic tumours: | ||
{| class="wikitable" | {| class="wikitable sortable" | ||
!Tumour | |||
!Usual sex | |||
!Age (years) | |||
!Usual site | |||
!Typical <br>size (cm) | |||
![[Gross pathology]] | |||
|- | |- | ||
|Serous microcystic<br> adenoma | |[[serous microcystic adenoma|Serous microcystic<br> adenoma]] | ||
|female | |female | ||
|66 | |66 | ||
Line 356: | Line 334: | ||
|[http://www.joplink.net/prev/200905/25_fig06.jpg (joplink.net]<ref>URL: [http://www.joplink.net/prev/200905/25.html http://www.joplink.net/prev/200905/25.html]. Accessed on: 15 February 2012.</ref>, [http://oac.med.jhmi.edu/cpc/images/cpc5/33.jpg (jhmi.edu)]<ref name=jhmi>URL: [http://oac.med.jhmi.edu/cpc/cases/cpc5/cpc5_answer.html http://oac.med.jhmi.edu/cpc/cases/cpc5/cpc5_answer.html]. Accessed on: 15 February 2012.</ref> | |[http://www.joplink.net/prev/200905/25_fig06.jpg (joplink.net]<ref>URL: [http://www.joplink.net/prev/200905/25.html http://www.joplink.net/prev/200905/25.html]. Accessed on: 15 February 2012.</ref>, [http://oac.med.jhmi.edu/cpc/images/cpc5/33.jpg (jhmi.edu)]<ref name=jhmi>URL: [http://oac.med.jhmi.edu/cpc/cases/cpc5/cpc5_answer.html http://oac.med.jhmi.edu/cpc/cases/cpc5/cpc5_answer.html]. Accessed on: 15 February 2012.</ref> | ||
|- | |- | ||
|Intraductal papillary<br>mucinous tumour (IPMT) | |[[IPMN|Intraductal papillary<br>mucinous tumour (IPMT)]] | ||
|male | |male | ||
|62 | |62 | ||
Line 370: | Line 348: | ||
|[http://radiology.rsna.org/content/251/1/77/F8.expansion.html (rsna.org)] | |[http://radiology.rsna.org/content/251/1/77/F8.expansion.html (rsna.org)] | ||
|- | |- | ||
|Solid pseudopapillary<br> tumour | |[[solid pseudopapillary tumour|Solid pseudopapillary<br> tumour]] | ||
|female | |female | ||
|35 | |35 | ||
Line 379: | Line 357: | ||
=Cystic lesions= | =Cystic lesions= | ||
==Serous | ==Serous tumours - overview== | ||
===General=== | ===General=== | ||
*Cell of origin: intralobular duct cells (ductular cells). | *Cell of origin: intralobular duct cells (ductular cells). | ||
*Glycogen rich - but do not produce mucin. | *Glycogen rich - but do not produce mucin. | ||
===Subclassication=== | ====Subclassication==== | ||
*Serous microcystic adenoma ([[AKA]] serous cystadenoma<ref name=Ref_Sternberg4_1630>{{Ref Sternberg4|1630}}</ref>). | *[[Serous microcystic adenoma]] ([[AKA]] serous cystadenoma<ref name=Ref_Sternberg4_1630>{{Ref Sternberg4|1630}}</ref>). | ||
** Many small cysts. | ** Many small cysts. | ||
*Serous oligocystic adenoma. | *Serous oligocystic adenoma. | ||
Line 394: | Line 372: | ||
*If one mucin +ve cell, tumour = a mucinous tumour. | *If one mucin +ve cell, tumour = a mucinous tumour. | ||
== | ==Serous cystadenoma of the pancreas== | ||
* | *[[AKA]] ''serous microcystic adenoma'',<ref name=Ref_Sternberg4_1630>{{Ref Sternberg4|1630}}</ref> [[AKA]] ''pancreatic serous cystadenoma''. | ||
{{Main|Serous cystadenoma of the pancreas}} | |||
==Mucinous cystic neoplasms of the pancreas== | |||
==Mucinous cystic | |||
*Gastro-entero-pancreatic cell differentiation with hypercellular ovarian-type stroma. | *Gastro-entero-pancreatic cell differentiation with hypercellular ovarian-type stroma. | ||
**Stroma --> cellular. | **Stroma --> cellular. | ||
Line 468: | Line 410: | ||
*"Ovarian-type stroma" under epithelium. | *"Ovarian-type stroma" under epithelium. | ||
**Ovarin-type stroma: high density of small (non-wavy) spindle cells with eosinophilic cytoplasm. | **Ovarin-type stroma: high density of small (non-wavy) spindle cells with eosinophilic cytoplasm. | ||
Notes: | Notes: | ||
*Appearance similar to ''mucinous cystadenoma'' in the [[ovarian tumours|ovary]]. | *Appearance similar to ''mucinous cystadenoma'' in the [[ovarian tumours|ovary]]. | ||
*Mucin stains +ve (intracytoplasmic). | *Mucin stains +ve (intracytoplasmic). | ||
=====Images===== | |||
<gallery> | |||
Image:Benign_pancreatic_mucinous_cystic_neoplasm_-_very_low_mag.jpg | Benign mucinous cystic neoplasm - very low mag. (WC) | |||
Image:Benign_pancreatic_mucinous_cystic_neoplasm_-_low_mag.jpg | Benign mucinous cystic neoplasm - low mag.(WC) | |||
Image:Benign_pancreatic_mucinous_cystic_neoplasm_-_intermed_mag.jpg | Benign mucinous cystic neoplasm - intermed. mag. (WC) | |||
Image:Benign_pancreatic_mucinous_cystic_neoplasm_-_high_mag.jpg | Benign mucinous cystic neoplasm - showing stroma - high mag. (WC) | |||
</gallery> | |||
www: | |||
*[http://radiology.uchc.edu/eAtlas/Images/GYN/5705b.gif Mucinous cystadenoma - ovary (uchc.edu)]. | |||
[[File:4 477025809 sl 1.png|Mucinous cystic neoplasm of pancreas]] | |||
[[File:4 477025809 sl 2.png|Mucinous cystic neoplasm of pancreas]] | |||
[[File:4 477025809 sl 3.png|Mucinous cystic neoplasm of pancreas]] | |||
[[File:4 477025809 sl 4.png|Mucinous cystic neoplasm of pancreas]] | |||
[[File:4 477025809 sl 5.png|Mucinous cystic neoplasm of pancreas]] | |||
[[File:4 477025809 sl 6.png|Mucinous cystic neoplasm of pancreas]] | |||
[[File:4 477025809 sl 7.png|Mucinous cystic neoplasm of pancreas]]<br> | |||
Benign mucinous cystic neoplasm of pancreas in a 62 year old woman. A. CT scan showed a peripherally calcified spheroidal mass at the tail of the pancreas. Cytology only showed debris and inflammatory cells, but CEA of the fluid was 2875.2 ng/mL. B. Almost all sections of the cyst showed acellular debris topping a fibrous, often calcified wall, consistent with a pseudocyst. C. Extensive sampling, undertaken because of the high CEA, revealed rare sections with a lining. D. Lining nuclei are bland, with even chromatin. Shape and size variation, as well as darkening when shrunken, are all explicable by degeneration. E. Within distal pancreas, a focus of changes of chronic pancreatitis is seen upper left, while a pancreatic duct in lower right shows an intraductal proliferation. F. Tumor cells show mucinous vacuoles, with better preserved nuclei. Nuclear appearances remain bland. G. Cellular ovarian stroma appeared beneath epithelium of a separate focus of the cystic neoplasm. | |||
====Borderline mucinous cystic tumour==== | ====Borderline mucinous cystic tumour==== | ||
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*Cells floating in mucin. | *Cells floating in mucin. | ||
====Mucinous tumour | ====Mucinous tumour versus pseudocyst==== | ||
{| class="wikitable" | {| class="wikitable sortable" | ||
! Finding | |||
! Mucinous tumour | |||
! Pseudocyst | |||
|- | |- | ||
|Amylase & lipase || low || high | |Amylase & lipase || low || high | ||
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|Viscosity || high || low | |Viscosity || high || low | ||
|- | |- | ||
|CEA, CA125 || high || low | |[[CEA]], CA125 || high || low | ||
|} | |} | ||
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==Intraductal papillary mucinous tumour== | ==Intraductal papillary mucinous tumour== | ||
* | *Abbreviated ''IPMT''. | ||
*[[AKA]] ''intraductal papillary mucinous neoplasm | *[[AKA]] ''intraductal papillary mucinous neoplasm'', abbreviated ''IPMN''. | ||
{{Main|Intraductal papillary mucinous tumour}} | |||
==Solid pseudopapillary tumour== | ==Solid pseudopapillary tumour== | ||
*[[AKA]] ''solid pseudopapillary neoplasm''. | *[[AKA]] ''solid pseudopapillary neoplasm'', abbreviation ''SPN''. | ||
*[[AKA]] ''solid and papillary epithelial neoplasm'', abbreviated ''SPEN''.<ref>URL: [http://brighamrad.harvard.edu/Cases/bwh/hcache/360/full.html http://brighamrad.harvard.edu/Cases/bwh/hcache/360/full.html]. Accessed on: 31 October 2011.</ref> | *[[AKA]] ''solid and papillary epithelial neoplasm'', abbreviated ''SPEN''.<ref>URL: [http://brighamrad.harvard.edu/Cases/bwh/hcache/360/full.html http://brighamrad.harvard.edu/Cases/bwh/hcache/360/full.html]. Accessed on: 31 October 2011.</ref> | ||
{{Main|Solid pseudopapillary tumour}} | |||
=Pre-malignant lesions= | =Pre-malignant lesions= | ||
==Pancreatic intraepithelial neoplasia== | ==Pancreatic intraepithelial neoplasia== | ||
*Abbreviated ''PanIN''. | *Abbreviated ''PanIN''. | ||
{{Main|Pancreatic intraepithelial neoplasia}} | |||
=Solid tumours= | =Solid tumours= | ||
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*[[AKA]] ''ductal adenocarcinoma''. | *[[AKA]] ''ductal adenocarcinoma''. | ||
*[[AKA]] ''pancreatic ductal adenocarcinoma''. | *[[AKA]] ''pancreatic ductal adenocarcinoma''. | ||
*[[AKA]] ''pancreatic adenocarcinoma''. | |||
{{Main|Invasive ductal carcinoma of the pancreas}} | |||
==Pancreatic neuroendocrine tumour== | ==Pancreatic neuroendocrine tumour== | ||
*Abbreviated ''PanNET''.<ref name=pmid22198808/> | *Abbreviated ''PanNET''.<ref name=pmid22198808/> | ||
*[[AKA]] ''pancreatic islet cell tumour'' | *[[AKA]] ''pancreatic islet cell tumour''<ref name=pmid22198808>{{Cite journal | last1 = Burns | first1 = WR. | last2 = Edil | first2 = BH. | title = Neuroendocrine Pancreatic Tumors: Guidelines for Management and Update. | journal = Curr Treat Options Oncol | volume = | issue = | pages = | month = Dec | year = 2011 | doi = 10.1007/s11864-011-0172-2 | PMID = 22198808 }}</ref> - considered to be an outdated term. | ||
*[[AKA]] ''islet cell tumour'' | *[[AKA]] ''islet cell tumour'' - considered to be an outdated term. | ||
{{Main|Neuroendocrine tumour of the pancreas}} | |||
==Acinar cell carcinoma of the pancreas== | ==Acinar cell carcinoma of the pancreas== | ||
:'''Not''' to be confused with ''[[acinic cell carcinoma]]''. | :'''Not''' to be confused with ''[[acinic cell carcinoma]]''. | ||
*[[AKA]] ''acinar cell carcinoma''. | *[[AKA]] ''acinar cell carcinoma''. | ||
*[[AKA]] ''pancreatic acinar cell carcinoma''.<ref name=pmid>{{Cite journal | last1 = Thomas | first1 = PC. | last2 = Nash | first2 = GF. | last3 = Aldridge | first3 = MC. | title = Pancreatic acinar cell carcinoma presenting as acute pancreatitis. | journal = HPB (Oxford) | volume = 5 | issue = 2 | pages = 111-3 | month = | year = 2003 | doi = 10.1080/13651820310001153 | PMID = 18332967 }}</ref> | |||
{{Main|Acinar cell carcinoma of the pancreas}} | |||
=== | ==Pancreatoblastoma== | ||
{{Main|Pancreatoblastoma}} | |||
=See also= | =See also= | ||
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*[[Gastrointestinal pathology]]. | *[[Gastrointestinal pathology]]. | ||
*[[Von Hippel-Lindau syndrome]]. | *[[Von Hippel-Lindau syndrome]]. | ||
*[[IgG4-related systemic disease]]. | |||
=References= | =References= |
edits