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Test and teach number ninety eight: part 1
Pathology (2000) 32, pp. 39– 40
TEST AND TEACH Number Ninety Eight: Part 1 RICHARD WILLIAM SON , BARRY O’LOUGHLIN * AND NEAL WALKER Departments of Pathology and Surgery*, Royal Brisbane Hospital, Herston 4006, Australia See pages 60–62 for explanation and diagnosis
CASE REPORT A 24-year-old female university student presented at Royal Brisbane Hospital Outpatients Department in January 1996 having noticed a possible small upper abdominal lump 15 months previously and having visited her general practitioner 6 months later with upper abdominal discomfort. The general practitioner also palpated a lump, but believed it to be a consequence of constipation. At Outpatients, the patient complained of occasional nausea but denied any vomiting, change in bowel habit, weight loss, fever or night sweats. There was no significant past medical or family history, and she was receiving no medication. The patient looked well, but an 8 cm diameter smooth, firm and non-tender spherical mass was palpated in the left upper abdomen. CT scan confirmed a mass with mixed
Fig. 1 Cut surface of tumor.
attenuation closely related to the tail of the pancreas. At operation, a wellcircumscribed tumor arising from the inferior aspect of the body of the pancreas was locally excised after frozen section, suggested a serous cystadenoma of pancreas. The patient has subsequently remained well with no tumor recurrence. The surgical specimen comprised an encapsulated tumor 8 cm in diameter. Its cut surface was tan-colored with a spongy appearance (Fig. 1). No hemorrhage or necrosis was apparent. Histological sections showed a variety of appearances illustrated in Figs. 2– 4. Immunoperoxidase stains showed tumor cells strongly positive for neurone-specific enolase and variably positive for vimentin, a1 -antitrypsin and synaptophysin, but they were negative for cytokeratin, S100 protein, chromogranin, insulin, glucagon and somatostatin.
Fig. 2 Solid pattern comprising sheets of polyhedral tumor cells with regular round to oval nuclei with dispersed chromatin and small nucleoli. Some mitoses are seen (arrows) (H & E, ´ 180).
ISSN 0031–3025 printed/ISSN 1465– 3931 online/00/010039 – 02 © 1999 Royal College of Pathologists of Australasia
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TEST AND TEACH
Fig. 3 Predominantly trabecular pattern comprising cords of tumor cells separated by connective tissue septa centred on blood vessels. Note pseudomicrocyst (pseudogland) formed by pooling of myxoid connective tissue matrix (arrow) and cystic space left upper corner (H & E, ´ 130).
Pathology (2000), 32, February
Fig. 4 Pseudopapillary pattern with one to two layers of tumor cells lining elongated fibrovascular stalks (H & E, ´ 220).
TEST AND TEACH Number Ninety Eight: Part 1 RICHARD WILLIAM SON , BARRY O’LOUGHLIN * AND NEAL WALKER Departments of Pathology and Surgery*, Royal Brisbane Hospital, Herston 4006, Australia See pages 60–62 for explanation and diagnosis
CASE REPORT A 24-year-old female university student presented at Royal Brisbane Hospital Outpatients Department in January 1996 having noticed a possible small upper abdominal lump 15 months previously and having visited her general practitioner 6 months later with upper abdominal discomfort. The general practitioner also palpated a lump, but believed it to be a consequence of constipation. At Outpatients, the patient complained of occasional nausea but denied any vomiting, change in bowel habit, weight loss, fever or night sweats. There was no significant past medical or family history, and she was receiving no medication. The patient looked well, but an 8 cm diameter smooth, firm and non-tender spherical mass was palpated in the left upper abdomen. CT scan confirmed a mass with mixed
Fig. 1 Cut surface of tumor.
attenuation closely related to the tail of the pancreas. At operation, a wellcircumscribed tumor arising from the inferior aspect of the body of the pancreas was locally excised after frozen section, suggested a serous cystadenoma of pancreas. The patient has subsequently remained well with no tumor recurrence. The surgical specimen comprised an encapsulated tumor 8 cm in diameter. Its cut surface was tan-colored with a spongy appearance (Fig. 1). No hemorrhage or necrosis was apparent. Histological sections showed a variety of appearances illustrated in Figs. 2– 4. Immunoperoxidase stains showed tumor cells strongly positive for neurone-specific enolase and variably positive for vimentin, a1 -antitrypsin and synaptophysin, but they were negative for cytokeratin, S100 protein, chromogranin, insulin, glucagon and somatostatin.
Fig. 2 Solid pattern comprising sheets of polyhedral tumor cells with regular round to oval nuclei with dispersed chromatin and small nucleoli. Some mitoses are seen (arrows) (H & E, ´ 180).
ISSN 0031–3025 printed/ISSN 1465– 3931 online/00/010039 – 02 © 1999 Royal College of Pathologists of Australasia
40
TEST AND TEACH
Fig. 3 Predominantly trabecular pattern comprising cords of tumor cells separated by connective tissue septa centred on blood vessels. Note pseudomicrocyst (pseudogland) formed by pooling of myxoid connective tissue matrix (arrow) and cystic space left upper corner (H & E, ´ 130).
Pathology (2000), 32, February
Fig. 4 Pseudopapillary pattern with one to two layers of tumor cells lining elongated fibrovascular stalks (H & E, ´ 220).