Diagnostic Dilemma: A cystic mass of the pancreas was found in a 29 year old: is this a benign or cancerous cyst? (PN01-09)

Patient History:

A 29 year old woman was found to have a 4.3 X 3.5 cm cystic lesion in the head of the pancreas. Imaging, clinical and laboratory testing could not determine the diagnosis. A fine needle biopsy was then performed to determine a definitive diagnosis.

Original Diagnosis:

The fine needle aspiration cytology was reported as “suspicious for neoplasm”. This diagnosis did not distinguish between a benign or malignant tumor formation or specify the type of neoplasm that was present.

RedPath Diagnosis:

High grade neoplasia is definitely present. The fluid shows an elevated amount of good DNA with no k-ras-2 point mutations with six allelic mutations including three that are high amplitude. The molecular features indicate high grade pancreatic mucinous ductal dysplasia. Further, the amount and degree of accumulated mutational change points to a pancreatic endocrine tumor that will most likely become aggressive.

Generic sample of PathFinderTG® quantitative test results. NOTE: A diagnostic interpretation of the quantitative test results is provided by the RedPath Pathologist.
Click here for test result explanation

Clinical Impact:

Pancreatic endocrine neoplasia is rare prior to age 50. With a definitive diagnosis of high grade dysplasia, surgical excision is warranted at this time. Given the young age of the patient and the aggressive nature of this tumor, measures will be taken to specifically treat a diagnosed endocrine tumor.