Benign Pancreas Neoplasms Flashcards
Serous cystadenoma
Benign - usually found in the body or tail in patients >50 years of age. More common in women.
Some believe that very rarely you may get a serous cystadenocarcinoma, but it is morphologically identical and defined by metastatic disease - some say that these “metastases” just represent benign serous cystadenomas arising in other organs.
May be associated with Von-Hippel Lindau syndrome.
Gross: Cystic structure (usually multilocular, but may be unilocular), often with a central stellate scar.
Cyst typically lined by single layer of cuboidal to flat epithelial cells
* Clear to pale cytoplasm with sharp cell border
* Small, round to oval, uniform nuclei
* Periodic acid-Schiff without diastase has granular cytoplasmic staining
Exuberant rich capillary network immediately adjacent to epithelium
May have stellate scar that can be calcified
May occasionally show a solid histology, in which clear cells are strong mimics of metastatic RCC.
IHC: Cytokeratin, α-inhibin, calponin, GLUT1, MUC6 (+)
Molecular: von Hippel-Lindau (VHL) gene alteration detected in 30-90% of sporadic cases
What is the ddx for this histology in the pancreas?
Metastatic RCC versus solid serous cystadenoma
Resolve with PAX8, alpha inhibin.
Mucinous cystic neoplasm
Benign. Occurs most often in the tail or body of the pancreas. Occurs more commonly in females (20:1), ~50 years of age.
Gross: solitary, multilocular (rarely unilocular) cystic mass filled with mucin +/- admixed necrotic material. Cysts typically do not communicate with the ductal system, but may in rare cases.
Histology: Cysts lined by tall, columnar, mucin-producing cells with underlying ovarian-type stroma.
IHC: Stromal cells ER/PR/inhibin positive and may be luteinized.
