PMC4929393_01
Abdominal CT. Pancreatic tumor mass compared to the celiac region.
crg-0010-0174-g01.jpg
PMC4929393_01_crg-0010-0174-g01.jpg
F1
Unexpectedly, a rounded and well-delimited pancreatic tumor was discovered on the CT scan (fig. 1).
EUS. Rounded lesion with clear borders (arrow).
crg-0010-0174-g02.jpg
PMC4929393_01_crg-0010-0174-g02.jpg
F2
On endoscopic ultrasound (EUS), this homogeneous and hypoechoic lesion was separated from the liver and stomach by a hyperechoic border (fig. 2).
Appearance of a hypoechoic cavity within the lesion during puncture using EUS (arrow).
crg-0010-0174-g03.jpg
PMC4929393_01_crg-0010-0174-g03.jpg
F3
During the puncture, a hypoechoic cavity appeared inside the lesion (fig. 3).
A Positive staining with BCL10. x200. B Negative staining with CK7. There is a cytoplasmic background without membrane staining. x100.
crg-0010-0174-g04.jpg
PMC4929393_01_crg-0010-0174-g04.jpg
F4
Immunohistochemically, the tumor cells were positive for cytokeratin AE1/AE3, epithelial membrane antigen, and BCL10 (fig. 4A), and negative for CK7 (fig. 4B), CK20, chromogranin, and synaptophysin, consistent with ACC.
Abdominal CT. Bulky tumor mass in the pancreatic head measuring 80.3 mm (long axis).
crg-0010-0174-g05.jpg
PMC4929393_01_crg-0010-0174-g05.jpg
F5
A scan showed an 80-mm cephalic lesion in the pancreas composed of tissue and cysts, which was responsible for a retrodilation of the main pancreatic duct (fig. 5).
Therapeutic response obtained after 6 cycles of GEMOX treatment.
crg-0010-0174-g06.jpg
PMC4929393_01_crg-0010-0174-g06.jpg
F6
Following 6 cycles of chemotherapy, the primary lesion on the pancreatic head had disappeared (fig. 6) and a decrease in size of the liver metastases was observed.