Sandbox: DDx pancrease

, Adenosquamous carcinoma,  , Undifferentiated carcinoma, Undifferentiated carcinoma with osteoclast-like giant cell, ,  ,,  Schwannoma, Neurofibroma, , Intraductal tubular neoplasm (ITN), Metastases to pancreas, Von Hippel-Landau (VHL)-associated serous cystic neoplasm

• Done:

• • Zollinger-Ellison syndrome, Adenocarcinoma of pancreas, Solid-pseudopapillary tumour of pancreas, Insulinoma, Gastrinoma, Glucagonoma, VIPoma, Somatostatinoma

, , Intraductal papillary mucinous neoplasm, Mucinous cystic neoplasm, Pancreatic intraepithelial neoplasia, Pancreatoblastoma, Serous cystadenoma, carcinoma,Intraductal papillary mucinous neoplasm (IPMN), Serous cystadenoma, Mucinous cystic neoplasm, , ,, Pancreatic ductal adenocarcinoma Solid-pseudopapillary neoplasm

• Rare
  • Colloid carcinoma Hepatoid carcinoma Signet ring cell Pancreatic teratoma Pancreatic lymphoma Pancreatic Sarcoma

• Acinar cell carcinoma

• Adult male
  • Vague abdominal pain Subcutaneous fat necrosis
  • Polyarthralgia
  • Nonbacterial thrombotic endocarditis

• • Large solid mass
  • Hemorrhage and necrosis
  • Fibrous septa

• • Acinar cell differentiation
  • Stain +ve trypsin, chymotrypsin, elastase, AFP, or lipase
  • Presence of zymogen granules

alpha-fetoprotein posit pancreatic neoplasm ,

Characteristics	Insulinoma	Vipoma	Gastrinoma
Symptoms
Diaphoresis	Present	Absent	Absent
Watery diarrhea	Absent	Present	Absent
Heartburn	Absent	Absent	Present
Lab values
Hypoglycemia	Present	Absent	Absent
Hypokalemia	Absent	Present	Absent
Hypergastrinemia	Absent	Absent	Present
CT scan	Calcification and hyperattenuation of the mass	Hypervascularity with diffuse multiple metastatic nodulation	Small hypoattenuating nodule ± calcification
Histopathology	Solid or gyriform cellular patterns with amyloid deposition, absence of glands, and nesidioblastosis	Solid sheets with uniform cuboidal cells, centrally located nuclei, and granular cytoplasm	Lobular-trabecular pattern of gastrin positive tumor cells with infiltration of Brunner glands