肺腺癌，高分化。

 有胰腺肿块，转移性胰腺导管腺癌和原发肺腺癌都要考虑，做TTF-1,CA199,CK7,CK20,Villin看一下。谢谢沈老师。

 腺癌

Selective IHC results: CK7(+), CK20 Focal weakly (+), TTF-1(-)

Differential Diagnoses: lung primary or metastatic pancreatic adenocarcinoma

If lung primary, will consider Whipple surgery for pancreatic mass

If panreatic metastasis (stage IV), less likely to perform Whipple

What's the appropriate frozen diagnosis ?

What's the final diagnosis??   

结合病史和免疫组化，考虑 转移性腺癌。

 结合病史及免疫组化,考虑:转移性腺癌.(胰腺来源)

Frozen diagnosis: Adenocarcinoma with mucinous features
Final diagnosis: Adenocarcinoma with mucinous features, favor metastatic carcinoma of pancreas
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1. Very difficult to distinguish primary lung and metastatic mucinous adenocarcinoma (pancreatic) based on morphology; therefore do not give a definitive diagnosis of primary site
2. Immunostains cannot help: TTF1 cannot help (often negative), CK7/CK20 doesn't help either
3. In a patient with lung nodule and pancreatic mass, the chance of metastasis is higher than two separate tumors. Ask patient's history and clinical correlation.
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Welcome your comments and please share your interesting cases and lessons!

 谢谢

 Thanks for your presentation of such a good case!

 期待结果

 学习！

Final diagnosis we rendered is: Adenocarcinoma with mucinous features, favor metastatic carcinoma of pancreas

There is always an error when I try to finalize it! Can someone help?

 A very good  case  to study.

 腺癌，转移还是原发期待结果。

 癌？

 我们曾经遇到过肺类似的病例，肺组织里腺样结构异型性更大，粘液分泌更明显，但最后的讨论结果没有报癌。如果这例够癌，我们那例更应该报癌了