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David S Klimstra - One of the best experts on this subject based on the ideXlab platform.
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microcystic serous Cystadenoma of the pancreas with subtotal cystic degeneration another neoplastic mimic of pancreatic pseudocyst
The American Journal of Surgical Pathology, 2012Co-Authors: Nicole C Panarelli, Kay J Park, Ralph H Hruban, David S KlimstraAbstract:BACKGROUND: Pancreatic serous Cystadenomas are benign cystic neoplasms. Extensive degeneration mimicking a pancreatic pseudocyst has been described in several types of pancreatic neoplasms but has not been documented in serous Cystadenomas. We report subtotal cystic degeneration of microcystic serous Cystadenomas (MSCA) that produces radiographic, gross, and microscopic overlap with pancreatic pseudocyst. MATERIALS AND METHODS: Resected MSCA with degenerative change were identified from the pathology archives of Memorial Sloan-Kettering Cancer Center and Johns Hopkins Hospital. The clinical, radiographic, gross, and microscopic findings were reviewed. RESULTS: Eight MSCAs with subtotal cystic degeneration were retrieved from among 397 resected serous Cystadenomas (2.0%). There were 2 men and 6 women (mean age, 52 y). Available radiographic studies showed classic features of MSCA in 2 of 4 cases. Four cysts were unilocular, and 4 were multilocular. Gross features of MSCA were noted focally in the multilocular cases but were not evident in the unilocular examples. The predominant histologic features were those of pancreatic pseudocyst, including a fibrotic cyst wall lacking epithelium and instead composed of myofibroblastic proliferation, hemorrhage, and inflammation. Residual foci of MSCA were embedded in fibrosis, comprising 5% to 60% of the tumor volume. CONCLUSIONS: Most pancreatic serous Cystadenomas display characteristic morphology, including a glycogen-rich epithelial lining and prominent subepithelial capillaries; however, extensive degenerative macrocystic change can obscure these classic features. This phenomenon is to be distinguished from macrocystic serous Cystadenoma, in which thin-walled macrocystic spaces are epithelium lined. Thus, serous Cystadenoma should be included in the differential diagnosis of pancreatic masses with extensive degenerative cystic change.
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solid serous adenoma of the pancreas the solid variant of serous Cystadenoma
The American Journal of Surgical Pathology, 1996Co-Authors: Bayardo Perezordonez, Attia Naseem, Philip H Lieberman, David S KlimstraAbstract:: Serous Cystadenomas of the pancreas are uncommon benign neoplasms that occur most frequently in elderly females. Characteristically, the tumors have a spongy gross appearance and are composed of innumerable cysts lined by flat, cuboidal, and polygonal cells with clear to pale eosinophilic cytoplasm and round, hyperchromatic central nuclei. Macrocystic variants with an oligolocular gross appearance have also been described. In this report we describe a solid pancreatic neoplasm arising in a 70-year-old woman who remains well 5 years after a distal pancreatectomy. The well-circumscribed tumor measured 4.0 cm in maximal diameter and was formed by clear to pale polygonal to cuboidal cells arranged in nests, sheets, and trabeculae separated by thick fibrous bands. Although small acini with glandular spaces were present within the nests, cystic spaces were absent. Periodic acid-Schiff (PAS) and PAS-dismutase (PAS-D) stains revealed a large amount of cytoplasmic glycogen. The tumor cells were immunoreactive for CAM 5.2, epithelial membrane antigen, and neuron-specific enolase. The cytologic, histochemical, and immunohistochemical features of the tumor were indistinguishable from those of serous Cystadenomas; therefore, we believe this solid serous adenoma represents a solid variant of serous Cystadenoma. Recognition of this lesion is important because the vast majority of solid tumors in the pancreas are malignant. The differential diagnosis includes the rare primary clear-cell "sugar" tumor of the pancreas, clear cell carcinoma, clear cell islet cell tumor, and metastatic renal cell carcinoma.
Chia-tung Shun - One of the best experts on this subject based on the ideXlab platform.
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combined pancreatic endocrine tumor and serous Cystadenoma
Journal of the Formosan Medical Association, 2009Co-Authors: Minshu Hsieh, Yu-wen Tien, Chia-tung ShunAbstract:Pancreatic serous Cystadenomas account for 1-2% of all exocrine pancreatic tumors, and endocrine tumors account for 1-2% of all pancreatic neoplasms. The combination of pancreatic serous Cystadenoma and endocrine tumor is even rarer. Here, we report two cases of combined pancreatic serous adenoma and endocrine tumor. One was a 64-year-old woman with serous Cystadenoma and pancreatic endocrine tumor. The other case was a 28-year-old woman with von Hippel-Lindau disease with combined pancreatic serous oligocystic adenoma and well-differentiated malignant endocrine carcinoma. Reviewing the literature, we found 15 similar cases that showed two different age distributions and clinical presentations. Careful examination of benign serous Cystadenoma should be kept in mind during clinical practice, to rule out the possibility of combined malignant endocrine tumor. In addition, von Hippel-Lindau disease should also be suspected when a young adult presents with combination of pancreatic serous Cystadenoma and endocrine tumor.
Alain Sauvanet - One of the best experts on this subject based on the ideXlab platform.
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Mucinous Cystadenoma with mesenchymal over-growth: a new variant among pancreatic mucinous Cystadenomas?
Virchows Archiv, 2004Co-Authors: Adriana Handra-luca, Anne Couvelard, Alain Sauvanet, Jean-françois Fléjou, Claude DegottAbstract:We report an unusual type of mucinous Cystadenoma of the pancreas, characterised by a predominantly solid gross appearance due to the presence of an abundant ovarian-type stroma. The tumour, located in the body of the pancreas, was discovered after episodes of acute pancreatitis. It was composed of several mucus-secreting benign cysts placed within a highly cellular ovarian-type stroma, composed of undifferentiated spindle cells with mild atypia but without any increase of mitotic activity and with a low proliferative index. These cells expressed oestrogen and progesterone receptors, but they did not express CD34, CD117, p53 protein or bcl-2. Recognition of this peculiar mainly solid mucinous Cystadenoma containing an abundant ovarian-type stroma is difficult. It is conceivable that the mesenchymal component described in our case could represent an early stage in the development of sarcoma in mucinous Cystadenoma of the pancreas.
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macrocystic pancreatic Cystadenoma the role of eus and cyst fluid analysis in distinguishing mucinous and serous lesions
Gastrointestinal Endoscopy, 2004Co-Authors: Dermot Otoole, L Palazzo, Pascal Hammel, Lamia Ben Yaghlene, Anne Couvelard, Michele Felcedachez, Monique Fabre, Alain Dancour, Alain Aubert, Alain SauvanetAbstract:Abstract Background Benign pancreatic serous Cystadenoma usually is morphologically distinguishable from mucinous Cystadenomas, which require resection because of their malignant potential. A macrocystic variant of serous Cystadenoma recently has been described, rendering this important distinction more difficult. The aim of this study was to determine the EUS and tumor marker characteristics of mucinous Cystadenoma compared with macrocystic serous Cystadenomas. Methods Medical records for consecutive patients seen between 1995 and 2002, with a histopathologic diagnosis of mucinous Cystadenoma or macrocystic serous Cystadenoma after surgery, who had undergone a detailed EUS examination, including EUS-guided FNA, were retrospectively reviewed. Results A resection specimen was available for 32 mucinous Cystadenomas and 9 macrocystic serous Cystadenomas. No significant differences were observed with regard to clinical data (age, gender, presence of symptoms), lesion size, and location within the pancreas. All mucinous Cystadenomas had a discernible cyst wall (thickened, 66%; focal parietal nodules, 25%) compared with 56% of macrocystic serous Cystadenomas ( p p =0.04; statistical significance removed by the Bonferroni correction). Microcysts were only observed in macrocystic serous Cystadenomas (44%; p =0.0008). The combination of a cyst wall that is thickened and the absence of microcysts had a sensitivity of 100% and specificity of 78% for the diagnosis of mucinous Cystadenoma compared with macrocystic serous Cystadenoma. Although intracystic carbohydrate-associated antigen 72-4 and mucins M1 were non-discriminatory, low carcinoembryonic antigen ( p =0.0002 and p =0.0002). Conclusions Although there is considerable overlap, helpful EUS characteristics that differentiate mucinous Cystadenoma from macrocystic serous Cystadenoma include a thick cyst wall and microcysts. These features, coupled with analysis of aspirated fluid for tumor markers (especially carcinoembryonic antigen), should help to confirm the diagnosis.
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discrimination of unilocular macrocystic serous Cystadenoma from pancreatic pseudocyst and mucinous Cystadenoma with ct initial observations
Radiology, 2003Co-Authors: Frank Cohenscali, Pascal Hammel, Alain Sauvanet, Valerie Vilgrain, Giuseppe Brancatelli, Mariepierre Vullierme, Y MenuAbstract:PURPOSE: To compare the computed tomographic (CT) appearance of pancreatic unilocular macrocystic serous Cystadenoma, mucinous Cystadenoma, and pseudocyst to determine if there are findings that assist in the differential diagnosis. MATERIALS AND METHODS: CT findings in 33 patients (24 women, nine men; age range, 18–84 years; mean age, 41 years) with unilocular pancreatic lesions (macrocystic serous Cystadenoma, n = 12; mucinous Cystadenoma, n = 11; pseudocyst, n = 10) were retrospectively and jointly reviewed by two blinded observers. Twenty-three patients underwent helical CT, which included pancreatic and portal venous phase imaging with delays of 40 seconds and 65 seconds, respectively, after contrast material injection. Ten patients underwent conventional (nonhelical) CT. The number, size, location, and contour of lesions were reviewed, along with wall thickness and enhancement and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 22) or on a combi...
Jonathan I Epstein - One of the best experts on this subject based on the ideXlab platform.
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papillary Cystadenoma of the epididymis and broad ligament morphologic and immunohistochemical overlap with clear cell papillary renal cell carcinoma
The American Journal of Surgical Pathology, 2014Co-Authors: Russell Vang, Jonathan I EpsteinAbstract:Abstract Papillary Cystadenoma is an uncommon epithelial tumor, originating within the head of the epididymis and broad ligament. When the lesion is bilateral, it is associated with von Hippel-Lindau disease. Its resemblance to metastatic clear cell renal cell carcinoma (RCC) has been noted in the literature. Owing to the emergence of additional markers for RCCs, we have evaluated the immunohistochemical staining patterns of a series of 7 papillary Cystadenomas using CK7, RCC, PAX8, carbonic anhydrase IX, and AMACR. Six of the cases involved the epididymis, and 1 involved the broad ligament. The patients ranged in age from 20 to 65 years old. All of the tumors were unilateral and not known to be associated with von Hippel-Lindau disease. The lesions were composed of cystic structures, which focally contained papillary fibrovascular cores lined by cuboidal to columnar bland-appearing cells with clear cytoplasm. Another component was the presence of tubules, which focally had elongated profiles. Reverse polarity, wherein the nuclei are oriented toward the luminal surface with subnuclear vacuoles, was present focally in 4 cases and more extensively in a fifth case. Features associated with malignancy, such as mitotic figures, nuclear pleomorphism, and necrosis, were not identified. All lesions were strongly positive for CK7 and negative for RCC. Carbonic anhydrase IX was positive in all tumors (diffusely positive in 6, patchy in 1) with lack of staining in the apical portion of the cytoplasm (ie, cup-shaped staining). PAX8 showed diffuse positivity in 6 of the 7 lesions, with one of the epididymal cases showing negative staining. AMACR staining was negative in 5 of the 7 cases and showed only focal, weak staining in the remaining 2 cases. The current study more specifically demonstrated that papillary Cystadenoma does not resemble clear cell RCC. Rather, papillary Cystadenomas of the epididymis and broad ligament have identical morphology and immunohistochemical staining to clear cell papillary RCC. The diagnosis of papillary Cystadenoma can be established as clear cell papillary RCC to date has not exhibited metastatic behavior.
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clear cell papillary Cystadenoma of the epididymis and mesosalpinx immunohistochemical differentiation from metastatic clear cell renal cell carcinoma
The American Journal of Surgical Pathology, 2005Co-Authors: Hakan Aydin, Robert H Young, Brigitte M Ronnett, Jonathan I EpsteinAbstract:Abstract: Clear cell papillary Cystadenoma is a rare epithelial tumor of the epididymis, which may present as an isolated lesion or as a component of von Hippel-Lindau disease (VHLD). Recently, tumors have also been described in the female genital tract with similar histology. Recognition of clear cell papillary Cystadenoma is critical because of its association with VHLD and its potential diagnostic confusion with metastatic renal cell carcinoma because of a shared architecture and clear cells. In this study, we report on the immunohistochemical differentiation of 5 clear cell papillary Cystadenomas, 3 of the epididymis and 2 of the mesosalpinx, from metastatic renal cell carcinoma. In 2 cases, there was a history of renal cell carcinoma in the setting of VHLD; and in 1 of these cases, an epididymal papillary Cystadenoma was initially considered to be metastatic renal cell carcinoma. Immunohistochemically, tumor cells were moderately intensely positive for cytokeratin AE1/AE3 and epithelial membrane antigen, strongly positive for CK7 and negative for CK20 and RCC. Four of 5 cases were negative for CD10. This staining profile contrasts with that reported for clear cell renal cell carcinomas, which are typically negative for CK7 and immunoreactive for renal cell carcinoma (RCC) and CD10. Our findings indicate that, in cases where there is uncertainty about the histologic diagnosis of clear cell papillary Cystadenoma, the above immunohistochemical panel helps to rule out metastatic renal cell carcinoma.
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multilocular prostatic Cystadenoma with high grade prostatic intraepithelial neoplasia
Urology, 2003Co-Authors: Elizabeth A Allen, David A Brinker, Domenico Coppola, Jose I Diaz, Jonathan I EpsteinAbstract:Abstract Multilocular prostatic Cystadenoma is a rarely encountered neoplasm located in the midline between the bladder and rectum that is either attached to the prostate by a pedicle or separate from the prostate entirely. Histologically and immunohistochemically these lesions resemble benign prostate tissue. We report the first case of this entity for which multifocal high-grade prostatic intraepithelial neoplasia (PIN) is identified. Conceptually, the finding of high-grade PIN in multilocular prostatic Cystadenomas provides further evidence that these lesions are fully analogous to the prostate gland not only in their morphology and immunohistochemistry but also in their predilection for the same diseases.
Minshu Hsieh - One of the best experts on this subject based on the ideXlab platform.
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combined pancreatic endocrine tumor and serous Cystadenoma
Journal of the Formosan Medical Association, 2009Co-Authors: Minshu Hsieh, Yu-wen Tien, Chia-tung ShunAbstract:Pancreatic serous Cystadenomas account for 1-2% of all exocrine pancreatic tumors, and endocrine tumors account for 1-2% of all pancreatic neoplasms. The combination of pancreatic serous Cystadenoma and endocrine tumor is even rarer. Here, we report two cases of combined pancreatic serous adenoma and endocrine tumor. One was a 64-year-old woman with serous Cystadenoma and pancreatic endocrine tumor. The other case was a 28-year-old woman with von Hippel-Lindau disease with combined pancreatic serous oligocystic adenoma and well-differentiated malignant endocrine carcinoma. Reviewing the literature, we found 15 similar cases that showed two different age distributions and clinical presentations. Careful examination of benign serous Cystadenoma should be kept in mind during clinical practice, to rule out the possibility of combined malignant endocrine tumor. In addition, von Hippel-Lindau disease should also be suspected when a young adult presents with combination of pancreatic serous Cystadenoma and endocrine tumor.
