View source for Cytologically Yours: Unknowns: 201401: Case 1

==Clinical History==
72 year old female with jaundice and a pancreatic mass.

==Cytology==
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===Resident Questions===
* <spoiler text="Diagnosis?">
* Adenocarcinoma
** Most common malignant tumor of the pancreas
** Accounts for approximately 85 percent of all pancreatic tumors
** Patients are commonly women in the 6th and 7th decades of life
** Prognosis is poor 90 percent of patients die within a year of diagnosis
** Association with cigarette smoking, high fat diet, and diabetes mellitus
** Triad of weight loss, pain, and jaundice
** Usually involve the head of the pancreas 
** Can obstruct the biliary or pancreatic ducts which can cause a double duct sign on imaging and can also cause painless jaundice 
</spoiler>
* <spoiler text="What are some of the cytologic features that lead you to the diagnosis?">
* Cellular specimen
* Predominantly ductal type cells and sparse/absent acinar cells
* Pleomorphism
* Nuclear crowding and overlapping
* Nuclear enlargement (more than 2-3 times the size of red blood cells)
* Nuclear membrane irregularity
* Three dimensional configuration
* Drunken honeycomb
</spoiler>
* <spoiler text="Differential diagnosis?">  
* Chronic pancreatitis
** Occurs in 4th and 5th decades
** Lack of irregular nuclear contours, macronuclei, anisonucleosis
** Monolayer fragments with honeycomb pattern
** Cells with well defined cell borders
** Negative staining for p53 and CDx-2
** Positive staining for SMAD4
* Contaminant gastrointestinal epithelium
** Gastric 
*** Monolayered tissue fragments with honeycomb arrangement
*** Uniform nuclei
*** Luminal Brush border
** Intestinal
*** Large monolayered two dimensional tissue fragments
*** Honeycomb arrangement of cells
*** Intermixed goblet cells
*** Uniform round evenly spaced nuclei
** Positive staining for CDX-2 and SMAD4
** Negative staining for p53
* The presence of mitotic figures does not support the diagnosis of carcinoma. Mitotic figures can be seen in chronic pancreatitis.
</spoiler>

{{Cytologically Yours}}

[[Category:Unknowns]]