Pancreatic Pathology

FRCPath Part 2 Surgical Course Pancreatic Pathology Dr Emyr Benbow Dr Panagiota Kitsanta

About the exam • • • •

It is difficult (long, timed, lots to do) It is not impossible It is a general competency test The College want you to pass, but only if they think you’re safe • Appropriate preparation, writing quickly enough and keeping calm

General approach • • • • •

Do timed sets of slides Start writing sooner rather than later Look at the whole slide Describe what you see but be efficient Let the examiner know you know what you’re talking about • Look for the expected and the unexpected • Not everything will be cancer

Case 1

Case No 1

Case 1

Clinical History A 76 year old male IPMN ,Whipples

Case 1

Histopathology Images

Case 1

Diagnosis Intraductal papillary mucinous neoplasm, moderately well differentiated mucinous Adenocarcinoma (colloid carcinoma)

Marking Scheme 3.5

3.0

Confident response, knowledge of natural history

2.5

Confident diagnosis of malignancy, recognise IPMN

2.0

Not sure about invasion, suspicious, vague on IPMN

1.5 1.0

Case 1

Case 2

Case No 2

Case 2

Clinical History A 43 year old female stricture mid CBD, Whipples

Case 2

Histopathology Images

Case 2

Diagnosis Pancreatic ductal adenocarcinoma

Marking Scheme 3.5

3.0

PNI, LN met

2.5

Confident about Ca, spot other features

2.0

Differential, lacks confidence?

1.5 1.0

Case 2

Case 3

Case No 3

Case 3

Clinical History 49 year old female. Central pancreatectomy.

Mass body of pancreas

Case 3

Histopathology Images

Case 3

Diagnosis Microcystic serous cystadenoma

Marking Scheme 3.5

3.0 CPC info – vHL association, 60+

2.5 Good description and special stains, diagnosis

2.0 Confident about benign nature but not aware of entity 1.5 1.0

Case 3

Case 4

Case No 4

Case 4

Clinical History A 60 year old female with mass. Whipples.

Case 4

Histopathology Images

Case 4

Diagnosis Chronic pancreatitis with PanIN

Marking Scheme 3.5

3.0

Good description, talk about causes

2.5

Confident not Ca, reasons why not

2.0

Less confident but safe

1.5 1.0

Case 4

Case 5

Case No 5

Case 5

Clinical History 55 year old female with a pancreatic cyst.

Case 5

Histopathology Images

Case 5

Diagnosis Mucinous cystic tumour with mild dysplasia

Marking Scheme 3.5

3.0

Great CPC approach (female, distal, etc), sampling issues

2.5

Good description, note important features

2.0

Describe but miss preferred diagnosis

1.5 1.0

Case 5

Case 6

Case No 6

Case 6

Clinical History 73 year old female. Pancreatic mass

Case 6

Histopathology Images

Case 6

Diagnosis Distal pancreatectomy: Adenocarcinoma, likely metastatic pulmonary primary

Marking Scheme 3.5

3.0 Full CPC style approach

2.5 Suggest metastasis, safe approach

2.0 Malignant but presume pancreatic primary 1.5 1.0

Case 6

Case 7

Case No 7

Case 7

Clinical History A 19 year old male with an insulinoma

Case 7

Histopathology Images

Case 7

Diagnosis Well differentiated endocrine tumour, ?microadenoma, FH MEN I

Marking Scheme 3.5

3.0

Think about MEN 1, rest of pancreas

2.5

Good decription, good IHC

2.0

No preferred diagnosis

1.5 1.0

Case 7

Case 8

Case No 8

Case 8

Clinical History A 72 year old male. Distal pancreatectomy.

Case 8

Histopathology Images

Case 8

Diagnosis Diffuse large B cell lymphoma, immunoblastic variant with activated phenotype (WHO 2008)

Marking Scheme 3.5

3.0

B/G lymphoma in spleen? Further typing?

2.5

Good description, suggest IHC, preferred diagnosis

2.0

Lack confidence

1.5 1.0

Case 8

Any questions?