View source for Cytologically Yours: Unknowns: 201401: Case 3

==Clinical History==
45 year old male with weight loss and jaundice.

==Cytology==
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===Resident Questions===
* <spoiler text="Diagnosis?">__NOGLOSSARY__
* Chronic pancreatits
** Occurs in the 4th and 5th decades
** Clinically presents as chronic recurrent abdominal pain
** Triad steatorrhea, diabetes mellitus, and weight loss
** Can present as a solid mass in the head of the pancreas
** Radiologically can appear as an ill defined lobulated mass and the periphery of the lesion can look irregular
** Strictures of the biliary or pancreatic ducts occurs as well as calcification
</spoiler>
* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">__NOGLOSSARY__
* Variable cellularity depending on the fibrosis in the specimen, however usually low cellularity
* Smears are polymorphous (ductal cells, acinar cells, macrophages, inflammatory cells, fibrosis, debris, calcification, fat necrosis)
* Hyperplastic and atypical ductal cells can be present, and can make it difficult to distinguish from adenocarcinoma.
* Although markedly atypical cells may be present there will not be many and there will be no single atypical cells
* Reactive cells will not have anisonucleosis and will not have nuclear irregularity
* Ductal cells out number acinar cells (acinar atrophy)
</spoiler>
* <spoiler text="Differential diagnosis?">__NOGLOSSARY__
* Adenocarcinoma
** Occurs later (6th and 7th decades)
** Irregular nuclear contours, macronuclei, anisonucleosis
** Positive staining for p53 and CDx-2
** Negative staining for SMAD4
* The presence of mitotic figures does not support the diagnosis of carcinoma. Mitotic figures can be seen in chronic pancreatitis.
* Pancreatic cancer is often surrounded by a zone of pancreatitis, therefore pancreatits does not exclude malignancy nor does inflammation
</spoiler>

{{Cytologically Yours}}

[[Category:Unknowns]]