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谈东风病例2 Case T0002: 胰腺肿块

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楼主 发表于 2010-04-27 22:32|举报|关注(0)
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姓    名: ××× 性别:  15 年龄:  Boy
标本名称:  Pancreatic head
简要病史:  The patient had a recent car accident. Images show a 2.4 cm mass at the head of pancreas
肉眼检查:  2.5x2.2x1.8cm mass, not connected to the pancreatic duct. No capsule.

 

Microscopically, it is a solid vascular-rich mass. About 20% of the tumor shows clear cell changes. Tumor invades into the pancreatic parenchyma, with perineural invasion.

 

This was a consultation case. If only one unstained(白片) available, which IHC stain do you choose to do?

 

IMPRESSION: Main features: A solid, cellular tumor with bland cytology. Accordingly, all well differentiated pancreatic epithelial tumors,   mainly including 1)高分化内分泌瘤 2)实体假乳头肿瘤 3)高分化腺泡细胞癌 4)胰腺母细胞瘤 5)高分化胰腺腺癌, are within the differential diagnosis. However, this case lacks primitive cells and squamoid corpuscle (required for pancreatoblastoma胰腺母细胞瘤), lacks single prominent nucleoli(frequently seen in well differentiated acinar cell carcinoma高分化腺泡细胞癌),  classic "salt and pepper" chromatin (seen in well differentiated pancreatic endocrine neoplasma高分化内分泌瘤), or glandular element (seen in acinar cell carcinoma, endocrine neoplasm or well differentiated adenocarcinoma高分化胰腺腺癌). In addition to lack of the above findings, this bland-looking tumor shows the solid-papillae:a thin vascular core convered by several layers of epithelial cells, and clear cell change/foamy cell changes are helpful features, suggestive of a solid-pseudopapillary tumor.  However, IHC is needed to confrim the impression. A beta-catenin stain is recommended, and shows diffuse positive in this case. For educational purposes, additional IHC stains were performed in this case, and showing tumor cells positive for CD10, negative for neuroendocrine markers and trypin.

 

ANSWER:  Solid-pseudopapillary Tumor, also known as Papillary and Solid Epithelial Neoplasma.

 

Key Points:


** Though usually(more than 90%) it occurs in young female (average 27 years old) with a huge mass (average 9.5cm in size), it can rarely occurs in male.

** Every tumor starts with one stem cell. When solid-pseudopapillary tumor is small like this case, it lacks pseudopapillary/cystic growth pattern, which is due to loss of cells after degenerative/necrosis when it grows larger.

** Beta-catenin mutation is the molecular alteration of this tumor, therefore, virtually it is positive universally. A reminder, only beta-catenin of nuclear staining is true positive.

** Prognosis of the disease is favorable, although it is invasive, and sometimes with perineural invasion (in this case), and rarely with metastasis.


Happy Labor Day (May 1)!

  • 谈东风病例2 Case T0002: 胰腺肿块图1
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  • 谈东风病例2 Case T0002: 胰腺肿块图5
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  • 谈东风病例2 Case T0002: 胰腺肿块图6
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  • 谈东风病例2 Case T0002: 胰腺肿块图8
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  • 谈东风病例2 Case T0002: 胰腺肿块图9
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本帖最后由 于 2010-05-26 03:16:00 编辑
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×参考诊断
Solid-pseudopapillary tumor

小荷 离线

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1 楼    发表于2010-04-27 22:46:00举报|引用
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 祝贺谈老师传图成功
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宁静致远 离线

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2 楼    发表于2010-04-28 15:23:00举报|引用
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 侵犯神经  实性假乳头瘤 

                   胰母细胞瘤?

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wfbjwt 离线

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3 楼    发表于2010-04-28 17:23:00举报|引用
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 神经内分泌癌,SYN。
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XLJin8 离线

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4 楼    发表于2010-04-28 20:35:00举报|引用
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本帖最后由 于 2010-05-03 12:03:00 编辑

根据形态学,诊断需考虑下列4种。
1)腺泡细胞癌;
2)高分化内分泌癌;
3)实体假乳头肿瘤;
4)胰腺母细胞瘤
结合临床和形体特点,主要鉴别诊断1与2:如果只有一张白片做IHC标记,我会选择胰蛋白酶
(Trypsin),阳性诊断腺泡细胞癌;阴性诊断内分泌癌。
2010-5-3 11:30am.
此病例如果是女性病人,我会首先考虑SPPN。我科已经累积了70多例SPPN病例,其中男性(通常男性病人平均年龄比女性大5-10岁)和大年龄女性病人确实有,但是比较少。
此例肿瘤很小,但明显浸润神经(在SPPN也比较少见)。
不知道此病例PR是否表达?
此外,SPPN可表达A1-AT、CyclinD1、CD56、NSE、Vimentin、CK等。
E-catenin基因3号外显子点突变是SPPN的分子遗传学特征。
IHC标记E-catenin,胰腺正常细胞-仅细胞膜表达E-catenin; SPPN - 细胞质和核均表达E-catenin.
感谢谈教授提供的好病例!

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曹大夫 离线

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5 楼    发表于2010-04-28 20:42:00举报|引用
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 实体假乳头肿瘤,做个beta-catenin或者CD10. 
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xianyuanqq82 离线

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6 楼    发表于2010-04-28 20:52:00举报|引用
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 胰腺肿瘤我们这边见得不多,请老师讲解
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xuleaf 离线

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7 楼    发表于2010-04-28 21:10:00举报|引用
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 倾向胰腺实性假乳头状瘤,一张白片做CD10
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每个人都有潜在的能量,只是很容易:被习惯所掩盖,被时间所迷离,被惰性所消磨.

谈东风 离线

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8 楼    发表于2010-04-28 23:27:00举报|引用
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Excellent discussions.

I would like to learn more from you.

The answer will be posted on April 30.

Thanks.

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knight 离线

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9 楼    发表于2010-04-29 23:22:00举报|引用
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 透明细胞型实体假乳头肿瘤,只做一个的话选择beta-catenin
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Zhangzy 离线

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10 楼    发表于2010-04-30 11:56:00举报|引用
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以下是引用knight在2010-4-29 23:22:00的发言:

 透明细胞型实体假乳头肿瘤,只做一个的话选择beta-catenin

实性假乳头肿瘤,年龄部位和图像都比较符合。
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