112 A Different Outcome of Pancreatic Pseudocyst Presentation in a Male Patient. (11th January 2018)

• Record Type: Journal Article
• Authors: Matloob, Ammar; Raza, Roshan; Mahabir, Roshan
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S48
• Page End: S48
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx118.111
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Pancreatic pseudocysts account for majority of pancreatic cystic lesions, mucinous and serous cystic tumors represent up to 60% of all cystic lesions. Nevertheless, pancreatic cystic neoplasms occur less frequently than solid ones, but are now found with increasing frequency due to improvement and refining of modern imaging techniques. Here we present a 55-year-old man who presented to the emergency department with severe abdominal pain, with an initial work-up revealing an increase in serum lipase and imaging showing a 7.0 x 5.7 x 4.1 cm pseudocyst in the pancreatic head and uncinate process. Fine needle aspiration was inconclusive with atypical cells and mucinous background. A subsequent Whipple procedure was performed with resection of a portion of the stomach (7.2 x 6.2 x 3.0 cm), a portion of the duodenum (28.2 x 6.2 x 2.0 cm), and an attached portion of the pancreas (8.5 x 6.5 x 5.2 cm). On gross examination, the pancreatic portion revealed a 6.2 x 5.2 x 4.1 cm unilocular cyst with smooth, focally hemorrhagic cystic wall, and cloudy, hemorrhagic intraluminal contents. Microscopically, the cyst was composed of predominantly denuded, cuboidal to columnar mucinous epithelium in a background of atrophic chronic pancreatitis, and neuroendocrine hyperplasia. No ovarian-type stroma was identified. Immunohistochemical study showed CK7, MUC-5AC, synaptophysin, and chromogranin (focal) were positive, and CK20, CDX-2, MUC1, and MUC2 were negative. This immunoprofile is consistent with focal neuroendocrine hyperplasia. No increased IgG- and IgG4-positive plasma cells were identified. Even though the clinical and radiological findings were consistent with pseudocyst, histologically this was a mucinous neoplasm without ovarian stroma, which is an important histological distinction between mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, as the management and prognosis are different.