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General Surgery · Pancreatic and splenic surgery: recognition
Sample itemA young woman has an incidental large well-circumscribed pancreatic tail mass with mixed cystic and haemorrhagic areas and peripheral calcification. Tumour cells show a CTNNB1 mutation and nuclear beta-catenin. What is the most likely diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Solid pseudopapillary neoplasm
This low-grade malignant tumour of young women (Frantz tumour) is a large encapsulated mass with degeneration. Resection is usually curative. Serous cystadenoma is a microcystic honeycomb lesion, and mucinous cystic neoplasm has ovarian-type stroma with mucin.
Option by option
A. Solid pseudopapillary neoplasm (correct)
Correct. Young woman, haemorrhagic degeneration and beta-catenin mutation are characteristic.
B. Ductal adenocarcinoma
Ductal adenocarcinoma presents in older patients with an ill-defined hypovascular mass.
C. Serous cystadenoma
Serous cystadenoma shows a microcystic honeycomb with a central scar.
D. Mucinous cystic neoplasm
Mucinous cystic neoplasm has thick-walled macrocysts with mucin.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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