Residency Program - Case of the Month

History:

A 66-year-old female with a past medical history of peptic ulcer disease presents to the Emergency Department with 5 weeks of vague epigastric abdominal pain with non-bloody non-bilious emesis.  She does not report any weight loss, fever, chills or lymphadenopathy.

A week before, she was seen at an outside hospital with a chief complaint of abdominal pain and was given opioids and anti-reflux medicine, which did not improve her symptoms.  On her workup, labs were unremarkable, however, a CT scan demonstrated a large heterogeneous mass (7.2 x 6.3 x 6.6 cm) arising from the pancreatic body with chronic occlusion of the splenic vein.  The mass has a large cystic component which may be related to an associated pseudocyst or necrosis. Also, there are subcentimeter liver lesions. An ultrasound/doppler-guided fine needle aspiration was performed which showed the following images:

Fine needle aspiration of the pancreatic mass, 5X		Fine needle aspiration of the pancreatic mass showing giant cell and spindle cell morphology, 20X
Fine needle aspiration of the pancreatic mass, 20X		Fine needle aspiration of the pancreatic mass, cell block, 11X

Answer