A 48-year-old alcoholic man with recurrent episodes of acute pancreatitis develops a palpable epigastric mass 6 weeks after a severe attack. CT shows a 9 cm well-defined fluid collection in the lesser sac. Aspiration reveals fluid with very high amylase content. Histological examination of the cyst wall would show:
- A Columnar mucinous epithelium over ovarian-type stroma
- B Squamous metaplasia with keratin debris
- C Cuboidal glycogen-rich epithelium with central stellate scar
- D Granulation tissue and fibrous tissue without any epithelial lining ✓
Explanation
A pancreatic pseudocyst is a collection of enzyme-rich fluid enclosed by granulation tissue and fibrous wall formed after fat necrosis in acute pancreatitis. By definition it lacks an epithelial lining, which distinguishes it from true cysts and from cystic neoplasms. Mucinous cystic neoplasm has columnar mucinous epithelium with distinctive ovarian-type stroma and occurs almost exclusively in women. Serous cystadenoma has glycogen-rich cuboidal cells arranged around microcysts. Very high amylase in aspirated fluid supports communication with the pancreatic ductal system, confirming pseudocyst over neoplasm.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.