Pancreas

Exocrine carcinomas

Colloid carcinoma


Editorial Board Member: Raul S. Gonzalez, M.D.
Deputy Editor-in-Chief: Catherine E. Hagen, M.D.
Jennifer Vazzano, D.O., M.S.
Wei Chen, M.D., Ph.D.

Topic Completed: 25 May 2021

Minor changes: 25 May 2021

Copyright: 2002-2021, PathologyOutlines.com, Inc.

PubMed Search: Colloid carcinoma[TIAB] pancreas

Jennifer Vazzano, D.O., M.S.
Wei Chen, M.D., Ph.D.
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Cite this page: Vazzano J, Chen W. Colloid carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/pancreascolloid.html. Accessed October 21st, 2021.
Definition / general
  • Infiltrating ductal epithelial neoplasm of the pancreas characterized by the presence (in at least 80% of the neoplasm) of large extracellular stromal mucin pools containing suspended neoplastic cells (WHO)
Essential features
Terminology
  • Colloid carcinoma
  • Mucinous noncystic carcinoma
  • Gelatinous carcinoma
ICD coding
  • ICD-10: C25 - malignant neoplasm of pancreas
Epidemiology
  • 1 - 3% of malignant neoplasms of the exocrine pancreas
  • 27 - 70% of IPMNs with associated invasive adenocarcinoma have a colloid component (Pathology 2008;40:655)
Sites
  • Usually in the head of the pancreas
Pathophysiology
  • Inverse polarization of cells (mucin glycoproteins in stroma facing surfaces instead of luminal surface)
  • Expression of MUC2 (gel forming mucin, rare in cPDAC) and the absence of external lamina or basement membrane may lead to accumulation of extracellular mucin, which limits tumor spread and appears to have tumor suppressor activity (Am J Surg Pathol 2003;27:571, Mod Pathol 2002;15:1087)
Clinical features
  • Mean age: 61 years
  • M = F
  • Abdominal / epigastric pain (in contrast to back pain of cPDAC), pancreatitis (50% of patients), diarrhea, jaundice, weight loss
  • Larger (6.0 cm) compared with cPDAC, lower stage, better survival
  • Incisional biopsy may contribute to thromboembolic complications (Am J Surg Pathol 2001;25:26)
  • Pseudomyxoma peritonei can be a rare complication
Diagnosis
  • Based on extensively sampled resection specimen
Radiology description
  • Dilated ducts (sometimes filled with nodular lesions)
Radiology images

Images hosted on other servers:

CT scan

Prognostic factors
Case reports
Treatment
  • No specific treatment guidelines
Gross description
  • Large (mean 5 cm), well demarcated tumor
  • Solid, firm, gelatinous cut surface
Gross images

AFIP images

Whipple resection specimen

Microscopic (histologic) description
  • At least 80% of the neoplasm consists of large extracellular stromal mucin pools
  • Scanty carcinoma cells suspended within these mucin pools
    • Usually cuboidal or columnar cells
    • Cribriform or stellate clusters, strips of columnar cells, small tubules or signet ring cells
  • Incomplete lining of mucin lakes common
  • Mucin tends to be retained during histologic processing (in contrast to IPMN and MCN)
  • Muconodular invasive component of 1 cm or more
  • Usually arise in association with IPMN, MCN or tubular / tubulovillous adenoma
  • Perineural invasion and regional lymph node metastasis common
  • Reference: Am J Surg Pathol 2001;25:26
Microscopic (histologic) images

Contributed by Jennifer Vazzano, D.O., M.S. and Wei Chen, M.D., Ph.D.
Low power colloid carcinoma Intermediate power colloid carcinoma

Large mucin pools

Cytology description
  • Difficult to spread thinly on slides due to abundant mucus
  • Cellularity of malignant component may be low
Positive stains
Negative stains
Electron microscopy description
  • Mucigen granules on stromal surface, no basement membrane
Molecular / cytogenetics description
  • KRAS codon 12 mutation (33%); less frequent than cPDAC (> 90%)
  • TP53 mutation (22%)
  • High prevalence of somatic mutations in GNAS
  • Microsatellite stable, unlike mucinous carcinomas of colon (Mod Pathol 2003;16:537)
Sample pathology report
  • Distal stomach, duodenum and pancreatic head, pancreaticoduodenectomy:
    • Colloid carcinoma of the pancreas, arising in a background of high grade intraductal papillary mucinous neoplasm (IPMN)
    • Carcinoma involves the muscularis propria of the duodenum
    • Positive for perineural invasion
    • Negative for lymphovascular invasion
    • All margins of resection, negative for carcinoma or high grade dysplasia
    • Metastatic carcinoma involving one of seventeen lymph nodes (1/17)
    • Portion of benign stomach with chronic inactive gastritis, negative for Helicobacter pylori on H&E stained sections
Differential diagnosis
Board review style question #1

A 62 year old woman presented with a pancreatic head mass. Histologic sections demonstrate areas of irregular mucin pools with suspended clusters of malignant cells and also floating signet ring cells. However, no individual infiltrating signet ring cells are identified in the stroma. There is an intestinal type intraductal papillary mucinous neoplasm (IPMN) in the background; no conventional ductal adenocarcinoma component is seen. What is the diagnosis?

  1. Colloid carcinoma
  2. IPMN with rupture and extruded stromal mucin
  3. Mucinous cystadenocarcinoma
  4. Signet ring cell carcinoma
Board review style answer #1
A. Colloid carcinoma

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